Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.10.002
Lingliang Zhou MD , Gordon S. Doig PhD , Cheng Lv PhD , Lu Ke PhD , Weiqin Li PhD , for the Chinese Critical Care Nutrition Trials Group (CCCNTG)
Objective
There is uncertainty about whether early infusion of intravenous amino acids confers clinical benefits in critically ill patients. In this study, we aimed to test the hypothesis that intravenous amino acids could improve 90-day mortality in critically ill patients with normal kidney function.
Design
This is a multicentre, open-label, randomised, parallel-controlled trial.
Setting
20 ICUs across China.
Participants
1928 eligible critically ill patients with normal kidney function.
Interventions
In addition to standard care, patients assigned to the intervention group will receive a continuous infusion of amino acids at a rate to achieve a total daily protein intake of approximately 2.0 g/kg/day.
Main outcome measures
The primary endpoint is all-cause mortality at day 90 after randomisation. Secondary endpoints and process measures will also be reported. The primary conclusions will be based on a modified intention-to-treat analysis for efficacy.
Ethics and dissemination
This study was approved by the ethics committee of the Jinling Hospital, Nanjing University (2020-NZKY-014-02 for the original version and 2020-NZKY-014-06 for the revised version) and all the participating sites. Results will be disseminated through journal publications and conference presentations.
Registration
This study protocol was registered with the Chinese Clinical Trial Registry, and the identifier is ChiCTR2100053359 (https://www.chictr.org.cn/hvshowprojectEN.html?id=257327&v=1.7).
{"title":"The effect of early intravenous amino acid supplementation in critically ill patients without acute kidney injury: Protocol for a multicentre, randomised, parallel-controlled trial (the ESSENTIAL trial)","authors":"Lingliang Zhou MD , Gordon S. Doig PhD , Cheng Lv PhD , Lu Ke PhD , Weiqin Li PhD , for the Chinese Critical Care Nutrition Trials Group (CCCNTG)","doi":"10.1016/j.ccrj.2024.10.002","DOIUrl":"10.1016/j.ccrj.2024.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>There is uncertainty about whether early infusion of intravenous amino acids confers clinical benefits in critically ill patients. In this study, we aimed to test the hypothesis that intravenous amino acids could improve 90-day mortality in critically ill patients with normal kidney function.</div></div><div><h3>Design</h3><div>This is a multicentre, open-label, randomised, parallel-controlled trial.</div></div><div><h3>Setting</h3><div>20 ICUs across China.</div></div><div><h3>Participants</h3><div>1928 eligible critically ill patients with normal kidney function.</div></div><div><h3>Interventions</h3><div>In addition to standard care, patients assigned to the intervention group will receive a continuous infusion of amino acids at a rate to achieve a total daily protein intake of approximately 2.0 g/kg/day.</div></div><div><h3>Main outcome measures</h3><div>The primary endpoint is all-cause mortality at day 90 after randomisation. Secondary endpoints and process measures will also be reported. The primary conclusions will be based on a modified intention-to-treat analysis for efficacy.</div></div><div><h3>Ethics and dissemination</h3><div>This study was approved by the ethics committee of the Jinling Hospital, Nanjing University (2020-NZKY-014-02 for the original version and 2020-NZKY-014-06 for the revised version) and all the participating sites. Results will be disseminated through journal publications and conference presentations.</div></div><div><h3>Registration</h3><div>This study protocol was registered with the Chinese Clinical Trial Registry, and the identifier is ChiCTR2100053359 (<span><span>https://www.chictr.org.cn/hvshowprojectEN.html?id=257327&v=1.7</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 326-331"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.08.007
Caroline J. Killick MBBS, LLM, FCICM , Felix Oberender MBBS, PhD, FCICM , Subodh Ganu MBBS, MD, MClinEpi , Kristen Gibbons PhD
Objectives
The objective of this study was to describe current use, clinical practice, and outcomes of continuous renal replacement therapy (CRRT) in children in the intensive care unit (ICU) in Australia and New Zealand.
Design
retrospective, binational registry-based cohort study and electronic survey of clinical practice.
Setting
ICUs that contribute to the Australian and New Zealand Paediatric Intensive Care Registry and a survey conducted in November 2021 including ICUs accredited for paediatric intensive care training that provide CRRT for children were part of this study.
Participants
Patients aged <18 years who received renal replacement therapy (RRT) in the ICU were included. Analysis of Australian and New Zealand Paediatric Intensive Care Registry data encompassed admissions from 1 January 2016 to 31 December 2020.
Interventions
None.
Main outcome measures
.
Results
1378 of 58,736 (2.4%) ICU admissions received RRT (CRRT or peritoneal dialysis [PD]), of which 592 (1.0%) received CRRT. Patients receiving CRRT were older and had a median age of 43 months (interquartile range: 7–130 months) compared to 0.3 months (interquartile range: 0.1–2.6 months) for PD. CRRT was used more commonly in all patient groups (523/626, 84%), except those with congenital heart disease (CHD). The number of admissions receiving CRRT varied between units from 1 to 160 admissions for the 5-year period. Overall ICU mortality for CRRT was 30% (175/592). ICU mortality was the highest in neonates ([51/108] 47%) and in those with CHD ([40/69] 58%). ICU mortality for CRRT decreased over the 5-year study period (35%–22%, p = 0.025). The survey showed consistency in CRRT equipment used between units, but there were differences in choice of dialytic modality and anticoagulation regimen.
Conclusion
CRRT is used less frequently than PD in smaller children and in those with CHD. In all other cohorts, it is the predominant mode of RRT. ICU mortality rates were higher for CRRT than for PD, with a large variation in mortality rates across age and diagnostic groups. The CRRT mortality in ICU decreased over the 5 years of the study.
{"title":"Provision of continuous renal replacement therapy in children in intensive care in Australia and New Zealand","authors":"Caroline J. Killick MBBS, LLM, FCICM , Felix Oberender MBBS, PhD, FCICM , Subodh Ganu MBBS, MD, MClinEpi , Kristen Gibbons PhD","doi":"10.1016/j.ccrj.2024.08.007","DOIUrl":"10.1016/j.ccrj.2024.08.007","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to describe current use, clinical practice, and outcomes of continuous renal replacement therapy (CRRT) in children in the intensive care unit (ICU) in Australia and New Zealand.</div></div><div><h3>Design</h3><div>retrospective, binational registry-based cohort study and electronic survey of clinical practice.</div></div><div><h3>Setting</h3><div>ICUs that contribute to the Australian and New Zealand Paediatric Intensive Care Registry and a survey conducted in November 2021 including ICUs accredited for paediatric intensive care training that provide CRRT for children were part of this study.</div></div><div><h3>Participants</h3><div>Patients aged <18 years who received renal replacement therapy (RRT) in the ICU were included. Analysis of Australian and New Zealand Paediatric Intensive Care Registry data encompassed admissions from 1 January 2016 to 31 December 2020.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main outcome measures</h3><div>.</div></div><div><h3>Results</h3><div>1378 of 58,736 (2.4%) ICU admissions received RRT (CRRT or peritoneal dialysis [PD]), of which 592 (1.0%) received CRRT. Patients receiving CRRT were older and had a median age of 43 months (interquartile range: 7–130 months) compared to 0.3 months (interquartile range: 0.1–2.6 months) for PD. CRRT was used more commonly in all patient groups (523/626, 84%), except those with congenital heart disease (CHD). The number of admissions receiving CRRT varied between units from 1 to 160 admissions for the 5-year period. Overall ICU mortality for CRRT was 30% (175/592). ICU mortality was the highest in neonates ([51/108] 47%) and in those with CHD ([40/69] 58%). ICU mortality for CRRT decreased over the 5-year study period (35%–22%, <em>p</em> = 0.025). The survey showed consistency in CRRT equipment used between units, but there were differences in choice of dialytic modality and anticoagulation regimen.</div></div><div><h3>Conclusion</h3><div>CRRT is used less frequently than PD in smaller children and in those with CHD. In all other cohorts, it is the predominant mode of RRT. ICU mortality rates were higher for CRRT than for PD, with a large variation in mortality rates across age and diagnostic groups. The CRRT mortality in ICU decreased over the 5 years of the study.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 271-278"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.08.001
Paul Ross RN, MN , Darrel Du Plooy RN, PGDip ICU , Jayne Sheldrake RN, MSc , Laura Ronayne RN, PGCert ICU , Padraig Keogh RN, PGCert ICU , Kathleen Collins RN, MPH , Alex Simpson Data Analyst, MChem , David Pilcher MBBS, FCICM , Andrew Udy FCICM, PhD
Objective
To describe the epidemiology and clinical features of pressure injury (PI) development in adult patients supported with extracorporeal membrane oxygenation (ECMO).
Design
Retrospective, observational, cohort study from January 2018 to May 2023.
Setting
A single-centre high-volume ECMO specialist intensive care unit (ICU).
Participants
All adults (aged 18 y or more) admitted to ICU for more than 24 h.
Main Outcome Measures
Any PI developing more than 24 h after ICU admission.
Results
Five-hundred ICU patients were supported with ECMO during the study period. Excluding those <18 years of age and with an ICU length of stay of <24 h, 466 patients were included in the analysis. One-hundred-thirty-five (29.0%) patients acquired at least one PI during their ICU stay, with PI occurring in 80 patients (17.2%) whilst supported on ECMO. The PI incidence rate was 1.7 per 100 ECMO patient-days (confidence interval: 1.3–2.0). Patients with a PI were mechanically ventilated for longer, received more renal replacement therapy, manifested more delirium, and stayed longer in the ICU and hospital. Conversely, crude ICU and in-hospital mortality was lower in the PI group. A longer ECMO run time and a higher proportion of veno-venous ECMO was also noted in those with a PI. Factors independently associated with the acquisition of a PI were male gender, oral dietary intake, renal replacement therapy, and prolonged mechanical ventilation. The majority of the PIs acquired during ECMO were stage-two and were most commonly located on the neck and head (n = 25/96 PIs, 26.0%) and sacral region (n = 31/96 PIs, 32.3%). Only three PIs were in relation to the ECMO cannula, circuit, or dressing.
Conclusion
A significant proportion of patients develop PIs while receiving ECMO. Vigilance on the prevention of medical device related PI is required. Gender, renal replacement therapy, oral diet, and length of mechanical ventilation were independent predictors for PI development in this population.
{"title":"The epidemiology of pressure injuries in adult intensive care unit patients supported with extracorporeal membrane oxygenation","authors":"Paul Ross RN, MN , Darrel Du Plooy RN, PGDip ICU , Jayne Sheldrake RN, MSc , Laura Ronayne RN, PGCert ICU , Padraig Keogh RN, PGCert ICU , Kathleen Collins RN, MPH , Alex Simpson Data Analyst, MChem , David Pilcher MBBS, FCICM , Andrew Udy FCICM, PhD","doi":"10.1016/j.ccrj.2024.08.001","DOIUrl":"10.1016/j.ccrj.2024.08.001","url":null,"abstract":"<div><h3><em><strong>Objective</strong></em></h3><div>To describe the epidemiology and clinical features of pressure injury (PI) development in adult patients supported with extracorporeal membrane oxygenation (ECMO).</div></div><div><h3>Design</h3><div>Retrospective, observational, cohort study from January 2018 to May 2023.</div></div><div><h3>Setting</h3><div>A single-centre high-volume ECMO specialist intensive care unit (ICU).</div></div><div><h3>Participants</h3><div>All adults (aged 18 y or more) admitted to ICU for more than 24 h.</div></div><div><h3>Main Outcome Measures</h3><div>Any PI developing more than 24 h after ICU admission.</div></div><div><h3>Results</h3><div>Five-hundred ICU patients were supported with ECMO during the study period. Excluding those <18 years of age and with an ICU length of stay of <24 h, 466 patients were included in the analysis. One-hundred-thirty-five (29.0%) patients acquired at least one PI during their ICU stay, with PI occurring in 80 patients (17.2%) whilst supported on ECMO. The PI incidence rate was 1.7 per 100 ECMO patient-days (confidence interval: 1.3–2.0). Patients with a PI were mechanically ventilated for longer, received more renal replacement therapy, manifested more delirium, and stayed longer in the ICU and hospital. Conversely, crude ICU and in-hospital mortality was lower in the PI group. A longer ECMO run time and a higher proportion of veno-venous ECMO was also noted in those with a PI. Factors independently associated with the acquisition of a PI were male gender, oral dietary intake, renal replacement therapy, and prolonged mechanical ventilation. The majority of the PIs acquired during ECMO were stage-two and were most commonly located on the neck and head (<em>n</em> = 25/96 PIs, 26.0%) and sacral region (<em>n</em> = 31/96 PIs, 32.3%). Only three PIs were in relation to the ECMO cannula, circuit, or dressing.</div></div><div><h3>Conclusion</h3><div>A significant proportion of patients develop PIs while receiving ECMO. Vigilance on the prevention of medical device related PI is required. Gender, renal replacement therapy, oral diet, and length of mechanical ventilation were independent predictors for PI development in this population.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 227-240"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957650","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}
To describe the use of and outcomes from awake prone positioning (APP) in nonintubated patients with COVID-19 in Australian intensive care units (ICUs) in comparison to those who did not receive APP, and to explore the temporal relationship between publication of APP research and changes in clinical practice.
Design
Multicentre, observational cohort study.
Setting
Seventy-eight Australian ICUs participating in SPRINT-SARI Australia.
Participants
Adult patients with confirmed COVID-19 admitted to ICU from 27 February 2020 until 30 June 2022.
Main outcomes measures
Proportion of patients receiving APP, rates of invasive ventilation, hospital length of stay (LOS), in-hospital mortality.
Results
4711 patients were included in the analysis, of whom 28.6% (1347/4711) underwent APP. Use of APP rapidly increased during the Delta wave and then subsequently declined. Over this period, there were a total of 30 publications on APP. APP patients received a median of 2 (IQR 1–4) days prone positioning, were less unwell (median APACHE-II 13.0 vs. 15.0, p < 0.001), and were less likely to require invasive ventilation (27.9% vs. 34.9%, p < 0.001). Overall, there was no difference in hospital LOS (median 14 vs. 13 days, P = 0.420) or in-hospital mortality (HR 0.95, 0.8–1.11) in those that did and did not receive APP. However, in patients requiring invasive ventilation after their first day in the ICU, not receiving APP was associated with earlier time to intubation (median 1 vs. 3 days, p < 0.001) and lower adjusted in-hospital mortality (HR 0.70, CI 0.54–0.90).
Conclusions
APP was rapidly adopted into practice within Australian ICUs during the COVID-19 pandemic at the same time as a growing number of publications on the topic. A lower frequency of invasive ventilation was noted with APP overall, but in those who eventually required this intervention, APP was associated with greater risk-adjusted in-hospital mortality.
目的：比较澳大利亚重症监护病房（icu）非插管的COVID-19患者与未接受APP的患者清醒俯卧位（APP）的使用情况和结果，探讨APP研究发表与临床实践变化之间的时间关系。设计：多中心、观察队列研究。背景：78名澳大利亚icu参加SPRINT-SARI澳大利亚。参与者：2020年2月27日至2022年6月30日入住ICU的成年COVID-19确诊患者。主要结局指标：接受APP的患者比例、有创通气率、住院时间（LOS）、院内死亡率。结果：4711例患者纳入分析，其中28.6%（1347/4711）患者接受了APP治疗。APP的使用在Delta波期间迅速增加，随后下降。在此期间，共有30篇关于APP的出版物。APP患者接受俯卧位的中位数为2 （IQR 1-4）天，不适较少（APACHE-II中位数13.0 vs. 15.0, p）。结论：在COVID-19大流行期间，APP在澳大利亚icu中迅速被采用，同时有关该主题的出版物也越来越多。总的来说，APP患者有创通气的频率较低，但在最终需要这种干预的患者中，APP与更高的经风险调整的住院死亡率相关。
{"title":"Prone positioning of nonintubated patients with COVID-19 in Australian intensive care units","authors":"Barry Johnston FCICM, MBioEthics , Hannah Rotherham FCICM, MHSM , Peinan Zhao BEng(Hons)/BBiomedSc , Aidan Burrell MBBS, FCICM, PhD , Andrew Udy MBBS, FCICM, PhD","doi":"10.1016/j.ccrj.2024.08.002","DOIUrl":"10.1016/j.ccrj.2024.08.002","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the use of and outcomes from awake prone positioning (APP) in nonintubated patients with COVID-19 in Australian intensive care units (ICUs) in comparison to those who did not receive APP, and to explore the temporal relationship between publication of APP research and changes in clinical practice.</div></div><div><h3>Design</h3><div>Multicentre, observational cohort study.</div></div><div><h3>Setting</h3><div>Seventy-eight Australian ICUs participating in SPRINT-SARI Australia.</div></div><div><h3>Participants</h3><div>Adult patients with confirmed COVID-19 admitted to ICU from 27 February 2020 until 30 June 2022.</div></div><div><h3>Main outcomes measures</h3><div>Proportion of patients receiving APP, rates of invasive ventilation, hospital length of stay (LOS), in-hospital mortality.</div></div><div><h3>Results</h3><div>4711 patients were included in the analysis, of whom 28.6% (1347/4711) underwent APP. Use of APP rapidly increased during the Delta wave and then subsequently declined. Over this period, there were a total of 30 publications on APP. APP patients received a median of 2 (IQR 1–4) days prone positioning, were less unwell (median APACHE-II 13.0 vs. 15.0, p < 0.001), and were less likely to require invasive ventilation (27.9% vs. 34.9%, p < 0.001). Overall, there was no difference in hospital LOS (median 14 vs. 13 days, P = 0.420) or in-hospital mortality (HR 0.95, 0.8–1.11) in those that did and did not receive APP. However, in patients requiring invasive ventilation after their first day in the ICU, not receiving APP was associated with earlier time to intubation (median 1 vs. 3 days, p < 0.001) and lower adjusted in-hospital mortality (HR 0.70, CI 0.54–0.90).</div></div><div><h3>Conclusions</h3><div>APP was rapidly adopted into practice within Australian ICUs during the COVID-19 pandemic at the same time as a growing number of publications on the topic. A lower frequency of invasive ventilation was noted with APP overall, but in those who eventually required this intervention, APP was associated with greater risk-adjusted in-hospital mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 241-248"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.08.008
G. Pound BSc(Hons) Physio , D. Jones BSc(Hons) MBBS FRACP FCICM MD PhD , G.M. Eastwood RN BN BN(Hons) GDipNurs(CriCare) PhD , E. Paul BSc, MSc, PhD , A. Serpa Neto MD MSc PhD FCICM , C.L. Hodgson PhD FACP BAppSc(PT) MPhil PGDip(Cardio) , EXCEL Study Investigators on behalf of the International ECMO Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Objective
To describe the six-month functional outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA) in Australia.
Design
Secondary analysis of EXCEL registry data.
Setting
EXCEL is a high-quality, prospective, binational registry including adult patients who receive extracorporeal membrane oxygenation (ECMO) in Australia and New Zealand.
Participants
Patients reported to the EXCEL registry who received ECPR following IHCA and had the six-month outcome data available were included.
Main outcome measures
The primary outcome was functional outcome at six months measured using the modified Rankin scale (mRS). The secondary outcomes included mortality, disability, health status, and complications.
Results
Between 15th February 2019 and 31st August 2022, 113/1251 (9.0%) patients in the registry received ECPR following IHCA (mean age 50.7 ± 13.7 years; 79/113 (69.9%) male; 74/113 (65.5%) non-shockable rhythm). At 6 months, 37/113 (32.7%) patients were alive, most (27/34 [79.4%]) with a good functional outcome (mRS 0–3). Patients had increased disability [WHODAS % Score 25.58 ± 23.39% vs 6.45 ± 12.32%; mean difference (MD) [95% (confidence interval) CI] −19.13 (−28.49 to −9.77); p < 0.001] and worse health status [EuroQol five-dimension, five-level (EQ-5D-5L) index value 0.73 ± 0.23 vs. 0.89 ± 0.14; MD (95% CI) 0.17 (0.07 to 0.26); p = 0.003] at six months compared with the baseline. The patients reported a median of 4.5 (2–6) complications at six-month follow-up.
Conclusion
One in three patients who received ECPR following IHCA were alive at six months and most had a good functional outcome. However, survivors reported higher levels of disability and a worse health status at six months compared with the baseline and ongoing complications were common.
{"title":"Long-term outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest: Analysis of EXCEL registry data","authors":"G. Pound BSc(Hons) Physio , D. Jones BSc(Hons) MBBS FRACP FCICM MD PhD , G.M. Eastwood RN BN BN(Hons) GDipNurs(CriCare) PhD , E. Paul BSc, MSc, PhD , A. Serpa Neto MD MSc PhD FCICM , C.L. Hodgson PhD FACP BAppSc(PT) MPhil PGDip(Cardio) , EXCEL Study Investigators on behalf of the International ECMO Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.ccrj.2024.08.008","DOIUrl":"10.1016/j.ccrj.2024.08.008","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the six-month functional outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA) in Australia.</div></div><div><h3>Design</h3><div>Secondary analysis of EXCEL registry data.</div></div><div><h3>Setting</h3><div>EXCEL is a high-quality, prospective, binational registry including adult patients who receive extracorporeal membrane oxygenation (ECMO) in Australia and New Zealand.</div></div><div><h3>Participants</h3><div>Patients reported to the EXCEL registry who received ECPR following IHCA and had the six-month outcome data available were included.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was functional outcome at six months measured using the modified Rankin scale (mRS). The secondary outcomes included mortality, disability, health status, and complications.</div></div><div><h3>Results</h3><div>Between 15th February 2019 and 31st August 2022, 113/1251 (9.0%) patients in the registry received ECPR following IHCA (mean age 50.7 ± 13.7 years; 79/113 (69.9%) male; 74/113 (65.5%) non-shockable rhythm). At 6 months, 37/113 (32.7%) patients were alive, most (27/34 [79.4%]) with a good functional outcome (mRS 0–3). Patients had increased disability [WHODAS % Score 25.58 ± 23.39% vs 6.45 ± 12.32%; mean difference (MD) [95% (confidence interval) CI] −19.13 (−28.49 to −9.77); <em>p</em> < 0.001] and worse health status [EuroQol five-dimension, five-level (EQ-5D-5L) index value 0.73 ± 0.23 vs. 0.89 ± 0.14; MD (95% CI) 0.17 (0.07 to 0.26); <em>p</em> = 0.003] at six months compared with the baseline. The patients reported a median of 4.5 (2–6) complications at six-month follow-up.</div></div><div><h3>Conclusion</h3><div>One in three patients who received ECPR following IHCA were alive at six months and most had a good functional outcome. However, survivors reported higher levels of disability and a worse health status at six months compared with the baseline and ongoing complications were common.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 279-285"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.09.003
Ahmad Nasser MBChB, FCICM, ICU Consultant, Senior Lecturer , Anis Chaba MD , Kevin B. Laupland Prof UQ, MD, PhD , Mahesh Ramanan Ass Prof QUT, MBBS, FCICM , Alexis Tabah Ass Prof QUT, MD, FCICM , Antony G. Attokaran MBBS, FRACP , Aashish Kumar MBBS, FCICM , James McCullough Mmed, FCICM , Kiran Shekar Prof UQ, MBBS, FCICM, PhD , Peter Garrett MBBS, FCICM , Philippa McIlroy MBBS, FCICM , Stephen Luke Prof JCU, MBBS, FCICM , Siva Senthuran Prof JCU, MBBS, FCICM , Rinaldo Bellomo Prof Monash Uni, MD, PhD , Kyle C. White Senior Lect, UQ, MBBS, FCICM
Objective
Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.
Design
Multicentre retrospective cohort study.
Setting
Twelve ICUs in Queensland (QLD), Australia.
Participants
Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146–150 mmol·L−1), moderate (151–155 mmol·L−1) and severe (>155 mmol·L−1) ICU-acquired hypernatremia.
Main outcome measure
We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.
Results
Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2–6) d after ICU admission, while median time to peak serum sodium level was 5 (3–8) d. The median maximum sodium level across the cohort was 149 (147–152) mmol·L−1. The sodium correction rate was 1 mmol·L−1 per day, taking a median of 3 d (1–5) for sodium levels to return below 145 mmol·L−1. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.
Conclusions
In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.
{"title":"ICU-acquired hypernatremia: Prevalence, patient characteristics, trajectory, risk factors, and outcomes","authors":"Ahmad Nasser MBChB, FCICM, ICU Consultant, Senior Lecturer , Anis Chaba MD , Kevin B. Laupland Prof UQ, MD, PhD , Mahesh Ramanan Ass Prof QUT, MBBS, FCICM , Alexis Tabah Ass Prof QUT, MD, FCICM , Antony G. Attokaran MBBS, FRACP , Aashish Kumar MBBS, FCICM , James McCullough Mmed, FCICM , Kiran Shekar Prof UQ, MBBS, FCICM, PhD , Peter Garrett MBBS, FCICM , Philippa McIlroy MBBS, FCICM , Stephen Luke Prof JCU, MBBS, FCICM , Siva Senthuran Prof JCU, MBBS, FCICM , Rinaldo Bellomo Prof Monash Uni, MD, PhD , Kyle C. White Senior Lect, UQ, MBBS, FCICM","doi":"10.1016/j.ccrj.2024.09.003","DOIUrl":"10.1016/j.ccrj.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.</div></div><div><h3>Design</h3><div>Multicentre retrospective cohort study.</div></div><div><h3>Setting</h3><div>Twelve ICUs in Queensland (QLD), Australia.</div></div><div><h3>Participants</h3><div>Adult patients admitted to ICU from 2015 to 2021. Only the first ICU admission was considered, and we categorised patients into mild (146–150 mmol·L<sup>−1</sup>), moderate (151–155 mmol·L<sup>−1</sup>) and severe (>155 mmol·L<sup>−1</sup>) ICU-acquired hypernatremia.</div></div><div><h3>Main outcome measure</h3><div>We aimed to study the prevalence of ICU-AH, patient characteristics, trajectory, risk factors, and outcomes.</div></div><div><h3>Results</h3><div>Data from 55,255 ICU admissions were included in the analysis, of which 4146 (7.5 %) patients had ICU-AH. These were subcategorised into mild (n = 2,670, 4.8 %), moderate (n = 1,073, 1.9 %) and severe (n = 403, 0.73 %) forms. Median time to diagnosis was 4 (2–6) d after ICU admission, while median time to peak serum sodium level was 5 (3–8) d. The median maximum sodium level across the cohort was 149 (147–152) mmol·L<sup>−1</sup>. The sodium correction rate was 1 mmol·L<sup>−1</sup> per day, taking a median of 3 d (1–5) for sodium levels to return below 145 mmol·L<sup>−1</sup>. APACHE III score, invasive ventilation, fever, and diuretic use on the day before hypernatremia were independent risk factors for moderate or severe ICU-AH. After adjusting for confounders, all levels of hypernatremia were independently associated with an increased risk of 30-d in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>In a large multicentric study of critically ill patients, ICU-acquired hypernatremia occurred in one in eight admissions after a median of four days in the ICU and was preceded by identifiable and modifiable risk factors. If severe, its correction was slow, and normalisation was delayed. After adjusting for other factors, all levels of hypernatremia were an independent risk factor for 30-d in-hospital mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 303-310"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.10.001
Nutnicha Preeprem MD , Emily See MBBS BMedSci MSc PhD FRACP FCICM , Siva P. Namachivayam FCICM , Ben Gelbart MBBS PhD FRACP FCICM
Objective
Frusemide is a common diuretic administered to critically ill children intravenously, by either continuous infusion (CI) or intermittent bolus (IB). We aim to describe the characteristics of children who receive intravenous frusemide, patterns of use, and incidence of acute kidney injury (AKI), and to investigate factors associated with commencing CI.
Design
Retrospective observational study.
Setting
Paediatric intensive care unit (PICU), the Royal Children’s Hospital Melbourne.
Participants
Children who received intravenous frusemide during PICU admission lasting ≥24 h between 2017 and 2022.
Main outcome measures
The primary outcome was the daily dose of frusemide. Secondary outcomes included timing of therapy from PICU admission, fluid balance at frusemide initiation, additional diuretic therapy, and the incidence of AKI at admission and frusemide initiation. Children who received CI were compared with those who received IB only using multivariable logistic regression analyses.
Results
Nine thousand three ninety-four children were admitted during the study period. A total of 1387 children (15 %) received intravenous frusemide, including 220 children (16 %) by CI. The CI group were younger (132 vs 202 days, p = 0.01), had higher PIM-3 scores (2.2 vs 1.5, p-value <0.001), more congenital heart disease (CHD) (72.3 % vs 60.6 %, p <0.01), and higher incidence and severity of AKI at frusemide initiation than the IB group (65.7 % vs 40.1 %, p-value <0.001). CI were commenced later than IB (46 vs 19 h into admission, p <0.001) and at higher doses (4.3 vs 1.5 mg/kg/day, p-value <0.001). In multivariable analyses, CHD (aOR 1.67, 95 % CI 1.16-2.40, p <0.01) was associated with CI.
Conclusion
Frusemide infusions are administered more commonly to children with CHD, later in PICU admission, and at higher daily doses compared to IB. Children who receive CI have a higher incidence and severity of AKI at initiation.
目的：氟塞米是一种常见的利尿剂，用于重症儿童静脉注射，可通过连续输注（CI）或间歇丸（IB）。我们的目的是描述接受静脉注射氟塞胺的儿童的特征、使用模式和急性肾损伤（AKI）的发生率，并调查与开始CI相关的因素。设计：回顾性观察性研究。环境：儿科重症监护室（PICU），墨尔本皇家儿童医院。参与者：2017年至2022年PICU入院期间持续≥24 h静脉注射氟塞米的儿童。主要结局指标：主要结局指标为每日氟塞胺剂量。次要结局包括PICU入院时的治疗时间、氟塞米开始时的体液平衡、额外的利尿剂治疗以及入院时和氟塞米开始时AKI的发生率。采用多变量logistic回归分析对接受CI治疗的儿童与仅接受IB治疗的儿童进行比较。结果：在研究期间，共有九千三千九十四名儿童入院。共有1387名儿童（15%）接受静脉注射氟塞米，其中CI为220名儿童（16%）。CI组年轻(132 vs 202天,p = 0.01), PIM-3得分较高(2.2 vs 1.5,假定值p假定值p假定值p结论:速尿灵输液管理通常与CHD儿童,针对新生儿重症监护室医生在儿童重症监护室医生承认,和在更高的每日剂量相比,IB。孩子收到CI有更高的发病率和严重程度的阿基在启动。
{"title":"Continuous frusemide infusion versus intermittent bolus therapy in paediatric intensive care: A single centre retrospective study","authors":"Nutnicha Preeprem MD , Emily See MBBS BMedSci MSc PhD FRACP FCICM , Siva P. Namachivayam FCICM , Ben Gelbart MBBS PhD FRACP FCICM","doi":"10.1016/j.ccrj.2024.10.001","DOIUrl":"10.1016/j.ccrj.2024.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Frusemide is a common diuretic administered to critically ill children intravenously, by either continuous infusion (CI) or intermittent bolus (IB). We aim to describe the characteristics of children who receive intravenous frusemide, patterns of use, and incidence of acute kidney injury (AKI), and to investigate factors associated with commencing CI.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Paediatric intensive care unit (PICU), the Royal Children’s Hospital Melbourne.</div></div><div><h3>Participants</h3><div>Children who received intravenous frusemide during PICU admission lasting ≥24 h between 2017 and 2022.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was the daily dose of frusemide. Secondary outcomes included timing of therapy from PICU admission, fluid balance at frusemide initiation, additional diuretic therapy, and the incidence of AKI at admission and frusemide initiation. Children who received CI were compared with those who received IB only using multivariable logistic regression analyses.</div></div><div><h3>Results</h3><div>Nine thousand three ninety-four children were admitted during the study period. A total of 1387 children (15 %) received intravenous frusemide, including 220 children (16 %) by CI. The CI group were younger (132 vs 202 days, <em>p</em> = 0.01), had higher PIM-3 scores (2.2 vs 1.5, <em>p</em>-value <0.001), more congenital heart disease (CHD) (72.3 % vs 60.6 %, <em>p</em> <0.01), and higher incidence and severity of AKI at frusemide initiation than the IB group (65.7 % vs 40.1 %, <em>p</em>-value <0.001). CI were commenced later than IB (46 vs 19 h into admission, <em>p</em> <0.001) and at higher doses (4.3 vs 1.5 mg/kg/day, <em>p</em>-value <0.001). In multivariable analyses, CHD (aOR 1.67, 95 % CI 1.16-2.40, <em>p</em> <0.01) was associated with CI.</div></div><div><h3>Conclusion</h3><div>Frusemide infusions are administered more commonly to children with CHD, later in PICU admission, and at higher daily doses compared to IB. Children who receive CI have a higher incidence and severity of AKI at initiation.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 319-325"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.08.006
Atacan D. Ertugrul MD , Ary Serpa Neto PhD , Bentley J. Fulcher BPharmSci (Hons) , Anaïs Charles-Nelson PhD , Michael Bailey PhD , Aidan J.C. Burrell PhD , Shannah Anderson BS , Stephen Bernard MD , Jasmin V. Board MPH , Daniel Brodie MD , Heidi Buhr MScMed ClinEpid , D. James Cooper MD , Craig Dicker , Eddy Fan PhD , John F. Fraser PhD , David J. Gattas MMed ClinEpi , Ingrid K. Hopper PhD , Sue Huckson BappSc , Natalie J. Linke BN , Edward Litton PhD , Jing Kong
Objective
Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.
Design, setting, and participants
This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).
Results
Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65–1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66–1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37–5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.
Conclusion
There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
目的：体外膜氧合（ECMO）是一种高风险手术，具有显著的发病率和死亡率，并且存在不确定的容量与预后的关系，特别是在长期功能预后方面。本研究的目的是研究ECMO中心容积与长期死亡和残疾结局之间的关系。设计背景和参与者：这是一项注册嵌入观察队列研究。纳入双国ECMO登记（EXCEL）的患者。排除标准包括采用ECMO进行心肺移植的患者。数据包括人口统计数据、首次ECMO的临床信息以及通过电话采访获得的六个月的结果。主要结局是6个月时死亡或新的残疾。采用医院年度ECMO量进行多变量分析。大容量中心被定义为每年有bb30例ECMO病例，并对静脉-静脉（VV）、静脉-动脉（VA）和体外心肺复苏（ECPR）的ECMO亚组进行分析。结果：在1232例患者中，663例患者在大容量中心接受ECMO治疗，569例患者在小容量中心接受ECMO治疗。在VV-ECMO [or: 1.09 (0.65-1.83), p = 0.744]、VA-ECMO [or: 1.10 (0.66-1.84), p = 0.708]和ECPR-ECMO [or: 1.38 (0.37-5.08), p = 0.629]中，高容量ECMO和低容量ECMO中心的6个月死亡或新发残疾无差异。这一发现在所有敏感性分析中都持续存在，包括排除在高容量和低容量中心之间转移的患者。结论：在澳大利亚和新西兰的高容量和低容量ECMO中心之间，6个月的死亡或残疾没有差异，可能是由于目前的协调护理模式，包括在我们地区的高容量和低容量ECMO中心之间的患者转移和培训。
{"title":"Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months","authors":"Atacan D. Ertugrul MD , Ary Serpa Neto PhD , Bentley J. Fulcher BPharmSci (Hons) , Anaïs Charles-Nelson PhD , Michael Bailey PhD , Aidan J.C. Burrell PhD , Shannah Anderson BS , Stephen Bernard MD , Jasmin V. Board MPH , Daniel Brodie MD , Heidi Buhr MScMed ClinEpid , D. James Cooper MD , Craig Dicker , Eddy Fan PhD , John F. Fraser PhD , David J. Gattas MMed ClinEpi , Ingrid K. Hopper PhD , Sue Huckson BappSc , Natalie J. Linke BN , Edward Litton PhD , Jing Kong","doi":"10.1016/j.ccrj.2024.08.006","DOIUrl":"10.1016/j.ccrj.2024.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.</div></div><div><h3>Design, setting, and participants</h3><div>This is a registry-embedded observational cohort study. Patients were included if they were enrolled in the binational ECMO registry (EXCEL). The exclusion criteria included patients on ECMO for heart/lung transplants. Data included demographics, clinical information on their first ECMO run, and six-month outcomes obtained by telephone interview. The primary outcome was death or new disability at six months. A multivariable analysis was conducted using hospitals' annual ECMO volume. High-volume centres were defined as having >30 ECMO cases annually, and analyses were run on ECMO subgroups of veno-venous (VV), veno-arterial (VA), and extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Results</h3><div>Of 1232 patients, 663 patients were cared for on ECMO at high-volume centres and 569 patients at low-volume centres. There was no difference in six-month death or new disability between high- and low-volume ECMO centres in VV-ECMO [OR: 1.09 (0.65–1.83), p = 0.744], VA-ECMO [OR: 1.10 (0.66–1.84), p = 0.708], and ECPR-ECMO [OR: 1.38 (0.37–5.08), p = 0.629]. This finding was persistent in all sensitivity analyses, including exclusion of patients who were transferred between high- and low-volume centres.</div></div><div><h3>Conclusion</h3><div>There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 262-270"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.ccrj.2024.08.003
Melissa J. Ankravs BPharm MClinPharm , Andrew Udy FCICM PhD , Rinaldo Bellomo MD PhD , Jeffrey J. Presneill MBBS PhD , Laura Adams RN , Yasmine Ali Abdelhamid MBBS PhD FRACP FCICM , Michael Bailey PhD , Jasmin Board RN PostGradDipNurs (ICU) MPH , Kathleen Byrne RN MNSc , Glenn Eastwood RN PhD , Maurice Le Guen MBBS MPH , Emma-Leah Martin BPharmSc MPH , Mark P. Plummer MBBS PhD , Megan Richardson BPharm GradDipClinPharm , Lucy Sharrock BPharm MHA , Meredith Young RN MPH , Adam M. Deane MBBS PhD
Background
Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.
Objective
The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.
Design, setting, participants, and interventions
This is a cluster-randomised, double-crossover, clinical trial. Critically ill adult patients admitted to three tertiary Australian intensive care units over a 12-month period will be eligible. Randomisation will occur at the site level, with allocation to open-label olanzapine or quetiapine use over four treatment periods of 3-month duration.
Main outcome measure
The primary outcome and days alive and delirium-/coma-free (censored at 14 days post enrolment) will be analysed using median quantile regression accounting for clustering at sites' level and time period and treatment order.
Results and conclusion
This trial will compare the effect of enteral olanzapine to quetiapine in critically ill adults with hyperactive delirium on an important indicator of patient outcome.
{"title":"Olanzapine versus quetiapine in critically ill patients with hyperactive delirium: Protocol for a multicentre, cluster-randomised, double-crossover, pragmatic clinical trial (CALM-ICU)","authors":"Melissa J. Ankravs BPharm MClinPharm , Andrew Udy FCICM PhD , Rinaldo Bellomo MD PhD , Jeffrey J. Presneill MBBS PhD , Laura Adams RN , Yasmine Ali Abdelhamid MBBS PhD FRACP FCICM , Michael Bailey PhD , Jasmin Board RN PostGradDipNurs (ICU) MPH , Kathleen Byrne RN MNSc , Glenn Eastwood RN PhD , Maurice Le Guen MBBS MPH , Emma-Leah Martin BPharmSc MPH , Mark P. Plummer MBBS PhD , Megan Richardson BPharm GradDipClinPharm , Lucy Sharrock BPharm MHA , Meredith Young RN MPH , Adam M. Deane MBBS PhD","doi":"10.1016/j.ccrj.2024.08.003","DOIUrl":"10.1016/j.ccrj.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.</div></div><div><h3>Objective</h3><div>The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.</div></div><div><h3>Design, setting, participants, and interventions</h3><div>This is a cluster-randomised, double-crossover, clinical trial. Critically ill adult patients admitted to three tertiary Australian intensive care units over a 12-month period will be eligible. Randomisation will occur at the site level, with allocation to open-label olanzapine or quetiapine use over four treatment periods of 3-month duration.</div></div><div><h3>Main outcome measure</h3><div>The primary outcome and days alive and delirium-/coma-free (censored at 14 days post enrolment) will be analysed using median quantile regression accounting for clustering at sites' level and time period and treatment order.</div></div><div><h3>Results and conclusion</h3><div>This trial will compare the effect of enteral olanzapine to quetiapine in critically ill adults with hyperactive delirium on an important indicator of patient outcome.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 249-254"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957633","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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