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Maiden MJ, Horton M, Power P, Knowles S, Hammond NE. Critically ill patients having time outdoors: prevalence and resources in Australia and New Zealand. Intensive Care Med 2024; 50:475-477. [PMID: 38421385 DOI: 10.1007/s00134-024-07355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia.
- Intensive Care Unit, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
- Department of Critical Care, The University of Melbourne, Parkville, VIC, Australia.
| | - Michelle Horton
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Paul Power
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
| | - Serena Knowles
- Critical Care Division, Faculty of Medicine, The George Institute for Global Health, UNSW, Sydney, Australia
| | - Naomi E Hammond
- Critical Care Division, Faculty of Medicine, The George Institute for Global Health, UNSW, Sydney, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
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Maiden MJ, Forehan S. The use of triiodothyronine during critical illness. Curr Opin Clin Nutr Metab Care 2024; 27:163-167. [PMID: 38170688 DOI: 10.1097/mco.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Thyroid hormone physiology changes during critical illness. Circulating concentration of triiodothyronine (T3), the active form of thyroid hormone decreases. It has long been uncertain whether this represents a pathologic change or if it is an adaptive phenomenon. Controlled clinical trials have been required to understand whether replacing and restoring serum T3 levels is therapeutic. RECENT FINDINGS Clinical trials of T3 have recently been proposed with some completed. These have been conducted in patients with sepsis, myocardial infarction, infants undergoing cardiac surgery, and acute respiratory distress syndrome. Of the completed trials, T3 administration restored serum concentrations, but was not accompanied by significant clinical benefit. Importantly, restoring serum T3 levels did not cause any adverse effects. SUMMARY If T3 is to be considered a therapeutic target in critical illness, further studies should consider the stage of disease it is administered, and whether there are other surrogate measures to assess adequacy of hormone replacement over and above serum T3 concentrations.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, The Royal Melbourne Hospital
- Department of Critical Care, The University of Melbourne
| | - Simon Forehan
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Victoria, Australia
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Witherspoon SA, Plowman SAJ, Power PZ, Mulvey A, Haines KJ, Maiden MJ. Low prevalence of communication between intensive care unit medical staff and general practitioners: A single-centre retrospective study. Aust Crit Care 2023; 36:1090-1094. [PMID: 37055244 DOI: 10.1016/j.aucc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND General practitioners (GPs) have a central role in delivering care to the Australian community, which includes coordinating management of chronic diseases and treatment of patients after admission to intensive care units (ICUs). Consultations between ICUs and GPs may become increasingly relevant as patients of advancing age and chronic disease burden are admitted to ICUs. However, how frequently and for what reason such consultations occur remain unclear. OBJECTIVES The objective of this study was to determine the prevalence and themes of consultations between ICU medical staff and GPs. METHODS Ten years of electronic medical records in the ICU of a regional Australian hospital were searched for patient admissions documenting the terms "gp", "general p∗", or "primary care∗" anywhere throughout the record. The proportion of ICU admissions in which a consultation between ICU staff members and GPs was documented was recorded along with the reason/s for the consultation and designation (resident, registrar, consultant) of those who communicated with the GP. MAIN OUTCOME MEASURES Main outcome measures included the proportion of ICU admissions with a documented consultation between ICU staff and GPs, theme of the consultation, and designation (resident, registrar, consultant) of those who communicated with the GP. RESULTS Of 13 402 admissions to the ICU, 137 (1.02%) had a documented consultation between ICU medical staff and GPs. Most consultations (n = 116, 85%) were initiated by junior ICU medical staff members seeking clinical information from the GPs. Few consultations were to discuss goals of care (n = 10, 7.3%) or care following ICU discharge (n = 15, 11%). CONCLUSIONS Consultations between ICU medical staff and GPs were infrequent. Further research is required on how best to integrate the health care provided by ICUs and GPs.
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Affiliation(s)
- Sophie A Witherspoon
- University of Melbourne Rural Clinical School, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne, VIC, Australia; Mount Isa Base Hospital, 30 Camooweal Street, Mount Isa, QLD, Australia.
| | | | - Paul Z Power
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia
| | - Anne Mulvey
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia
| | - Kimberley J Haines
- The University of Melbourne School of Medicine, Department of Critical Care, The University of Melbourne, Grattan Street, Parkville, VIC, Australia; Western Health Department of Physiotherapy, 176 Furlong Rd, St Albans, VIC, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia; The University of Melbourne School of Medicine, Department of Critical Care, The University of Melbourne, Grattan Street, Parkville, VIC, Australia; University of Adelaide Discipline of Acute Care Medicine, Adelaide, SA, Australia
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Mitra B, Maiden MJ, Read D, Nehme Z, Bernard S, Cameron PA. Definitive management of near-hanging at major versus non-major trauma centres. Emerg Med Australas 2023; 35:849-854. [PMID: 37325861 DOI: 10.1111/1742-6723.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The Victorian State Trauma System recommends that all major trauma patients receive definitive care at a major trauma service (MTS). The aim of the present study was to assess the outcomes of patients with major trauma after near-hangings who received definitive management at an MTS compared to a non-MTS. METHODS This was a registry-based cohort study of all adult (age ≥16 years) patients with near-hanging included in the Victorian State Trauma Registry from 1 July 2010 to 30 June 2019. Outcomes of interest were death at hospital discharge, time to death and extended Glasgow Outcome Scale (GOSE) score of 5-8 (favourable) at 6 months. RESULTS There were 243 patients included and 134 (55.1%) in-hospital deaths. Among patients presenting to a non-MTS, 24 (16.8%) were transferred to an MTS. There were 59 (47.6%) deaths at an MTS and 75 (63.0%) at a non-MTS (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.32-0.89). However, more patients were managed at a non-MTS after out-of-hospital cardiac arrest (58.8% vs 50.8%) and less patients had serious neck injury (0.8% vs 11.3%). After adjustment for out-of-hospital cardiac arrests and serious neck injury, management at an MTS was not associated with mortality (adjusted OR [aOR] 0.61; 95% CI 0.23-1.65) or favourable GOSE at 6 months (aOR 1.09; 95% CI 0.40-3.03). CONCLUSIONS After major trauma sustained from near-hanging, definitive management at an MTS did not offer a mortality benefit or better functional outcomes. Consistent with current practice, these findings suggest that most near-hanging related major trauma patients could be managed safely at a non-MTS.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Victoria, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Read
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Wraight TI, Namachivayam SP, Maiden MJ, Erickson SJ, Oberender F, Singh P, Gard J, Ganeshalingham A, Millar J. Trends in Childhood Oncology Admissions to ICUs in Australia and New Zealand. Pediatr Crit Care Med 2023; 24:e487-e497. [PMID: 37133322 DOI: 10.1097/pcc.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES There are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer. DESIGN Cohort study using a binational pediatric intensive care registry. SETTING Australia and New Zealand. PATIENTS Patients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr). CONCLUSIONS In Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling.
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Affiliation(s)
- Tracey I Wraight
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Siva P Namachivayam
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Clinical Haematology Department, The Royal Children's Hospital, Melbourne, VIC, Australia
- Monash Simulation, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Clinical Haematology Department, The Royal Children's Hospital, Melbourne, VIC, Australia
- Monash Simulation, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Simon J Erickson
- Paediatric Critical Care, Perth Children's Hospital, Perth, WA, Australia
| | - Felix Oberender
- Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Puneet Singh
- Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Jye Gard
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | - Johnny Millar
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Summers MJ, Chapple LAS, Bellomo R, Chapman MJ, Ferrie S, Finnis ME, French C, Hurford S, Kakho N, Karahalios A, Maiden MJ, O'Connor SN, Peake SL, Presneill JJ, Ridley EJ, Tran-Duy A, Williams PJ, Young PJ, Zaloumis S, Deane AM. Study protocol for TARGET protein: The effect of augmented administration of enteral protein to critically ill adults on clinical outcomes: A cluster randomised, cross-sectional, double cross-over, clinical trial. CRIT CARE RESUSC 2023; 25:147-154. [PMID: 37876373 PMCID: PMC10581259 DOI: 10.1016/j.ccrj.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background It is unknown whether increasing dietary protein to 1.2-2.0 g/kg/day as recommended in international guidelines compared to current practice improves outcomes in intensive care unit (ICU) patients. The TARGET Protein trial will evaluate this. Objective To describe the study protocol for the TARGET Protein trial. Design setting and participants TARGET Protein is a cluster randomised, cross-sectional, double cross-over, pragmatic clinical trial undertaken in eight ICUs in Australia and New Zealand. Each ICU will be randomised to use one of two trial enteral formulae for three months before crossing over to the other formula, which is then repeated, with enrolment continuing at each ICU for 12 months. All patients aged ≥16 years in their index ICU admission commencing enteral nutrition will be eligible for inclusion. Eligible patients will receive the trial enteral formula to which their ICU is allocated. The two trial enteral formulae are isocaloric with a difference in protein dose: intervention 100g/1000 ml and comparator 63g/1000 ml. Staggered recruitment commenced in May 2022. Main outcomes measures The primary outcome is days free of the index hospital and alive at day 90. Secondary outcomes include days free of the index hospital at day 90 in survivors, alive at day 90, duration of invasive ventilation, ICU and hospital length of stay, incidence of tracheostomy insertion, renal replacement therapy, and discharge destination. Conclusion TARGET Protein aims to determine whether augmented enteral protein delivery reduces days free of the index hospital and alive at day 90. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12621001484831).
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Affiliation(s)
- Matthew J. Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Marianne J. Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Craig French
- Intensive Care Unit, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Nima Kakho
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J. Maiden
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Stephanie N. O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sandra L. Peake
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jeffrey J. Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition, Alfred Hospital, Melbourne, Victoria, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia J. Williams
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Paul J. Young
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
| | - TARGET Protein Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Intensive Care Unit, Sunshine Hospital, Melbourne, Victoria, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, University Hospital Geelong, Geelong, Victoria, Australia
- Intensive Care Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Dietetics and Nutrition, Alfred Hospital, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Melbourne, Victoria, Australia
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Wigmore G, Deane AM, Anstey J, Bailey M, Bihari S, Eastwood G, Ghanpur R, Maiden MJ, Presneill JJ, Raman J, Bellomo R. Study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-ll (HAS FLAIR-II) trial. CRIT CARE RESUSC 2022; 24:309-318. [PMID: 38047012 PMCID: PMC10692638 DOI: 10.51893/2022.4.oa1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: Fluid bolus therapy with 20% albumin may shorten the duration of vasopressor therapy in patients after cardiac surgery. Objective: To describe the study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-II (HAS FLAIR-II) trial. Design, setting, participants and intervention: HAS FLAIR-II is a phase 2b, multicentre, parallel group, openlabel, randomised controlled trial that will be conducted at six Australian intensive care units. Patients requiring fluid bolus therapy after cardiac surgery will be randomly assigned in a 1:1 ratio to the intervention of fluid bolus therapy with 20% albumin or a comparator of fluid bolus therapy with a crystalloid solution. Main outcome measures: The primary outcome measure is the cumulative duration of vasopressor therapy. Secondary outcomes include vasopressor use, service utilisation, and mortality. All analyses will be conducted on an intention-to-treat basis. Results and conclusion: The study protocol and statistical analysis plan will guide the conduct and analysis of the HAS FLAIR-II trial, such that analytical and reporting biases are minimised. Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN No. 12620000137998).
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Affiliation(s)
- Geoffrey Wigmore
- Department of Anaesthesia, Western Health, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Adam M. Deane
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - James Anstey
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Shailesh Bihari
- Department of Intensive and Critical Care Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Rashmi Ghanpur
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Intensive care Unit, Warringal Private hospital, Melbourne, VIC, Australia
| | - Matthew J. Maiden
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
| | - Jeffrey J. Presneill
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jaishankar Raman
- University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Deakin University, Melbourne, VIC, Australia
- University of Illinois at Urbana-Champaign, Urbana (IL), USA
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - For the HAS FLAIR-II trial investigators
- Department of Anaesthesia, Western Health, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive and Critical Care Medicine, Flinders Medical Centre, Adelaide, SA, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Intensive care Unit, Warringal Private hospital, Melbourne, VIC, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Deakin University, Melbourne, VIC, Australia
- University of Illinois at Urbana-Champaign, Urbana (IL), USA
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Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Birardar V, Doherty S, Eastwood G, Finfer S, French CJ, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM. The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A multicenter, parallel-group, open-label, randomized clinical trial. Am J Respir Crit Care Med 2022; 206:874-882. [PMID: 35608484 DOI: 10.1164/rccm.202202-0329oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Blood glucose concentrations affect outcomes in critically ill patients but the optimal target blood glucose range in those with type 2 diabetes is unknown. Objective To evaluate the effects of a 'liberal' approach to targeted blood glucose range during intensive care unit (ICU) admission. Methods This mutlicenter, parallel-group, open-label, randomized clinical trial included 419 adult patients with type 2 diabetes expected to be in the ICU on at least three consecutive days. In the intervention group intravenous insulin was commenced at a blood glucose >252 mg/dL and titrated to a target range of 180 to 252 mg/dL. In the comparator group insulin was commenced at a blood glucose >180 mg/dL and titrated to a target range of 108 to 180 mg/dL. The primary outcome was incident hypoglycemia (<72 mg/dL). Secondary outcomes included glucose metrics and clinical outcomes. Main Results At least one episode of hypoglycemia occurred in 10 of 210 (5%) patients assigned the intervention and 38 of 209 (18%) patients assigned the comparator (incident rate ratio: 0.21 (95% CI, 0.09 to 0.49); P<0.001). Those assigned the intervention had greater blood glucose concentrations (daily mean, minimum, maximum), less glucose variability and less relative hypoglycaemia (P<0.001 for all comparisons). By day 90, 62 of 210 (29.5%) in the intervention and 52 of 209 (24.9%) in the comparator group had died (absolute difference 4.6 percentage points (95%CI, -3.9 to 13.2%); P=0.29). Conclusions A liberal approach to blood glucose targets reduced incident hypoglycemia but did not improve patient-centered outcomes. Clinical trial registration available at www.anzctr.org.au, ID: ACTRN12616001135404.
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Affiliation(s)
- Alexis P Poole
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Adelaide, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark E Finnis
- Royal Adelaide Hospital, Department of Critical Care Services, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
| | - James Anstey
- Saint Vincent's Hospital Melbourne, 60078, Department of Intensive Care, Fitzroy, Victoria, Australia
| | | | - Shailesh Bihari
- Flinders Medical Centre and Flinders University, Department of Intensive Care Medicine, Bedford park, South Australia, Australia
| | - Vishwanath Birardar
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Lyell McEwin Hospital, 3187, Intensive Care Unit, Elizabeth Vale, South Australia, Australia
| | - Sarah Doherty
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glenn Eastwood
- Austin hospital, Intensive care unit, Heidelgerg, Victoria, Australia
| | - Simon Finfer
- University of Sydney, Intensive Care, St. Leonards, New South Wales, Australia
| | - Craig J French
- Western Health, Victoria, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Simon Heller
- Clinical Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Michael Horowitz
- The University of Adelaide Adelaide Medical School, 110466, Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, South Australia, Australia
| | - Palash Kar
- The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter S Kruger
- Princess Alexandra Hospital, Intensive Care Unit, Brisbane, Queensland, Australia.,University of Queensland, Critical Care, Endocrinology and Metabolism Research Unit, Brisbane, Queensland, Australia
| | - Matthew J Maiden
- Royal Adelaide Hospital, Intensive Care Unit, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
| | - Johan Mårtensson
- Karolinska Institutet Department of Physiology and Pharmacology, 111126, Stockholm, Sweden.,Karolinska University Hospital, 59562, Perioperative Medicine and Intensive Care, Stockholm, Sweden
| | | | - Shay P McGuinness
- Auckland District Health Board, Cardiothoracic and Vascular ICU, Aucklanad, New Zealand
| | - Paul J Secombe
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Intensive Care, Alice Springs Hospital, Alice Springs, Australia
| | - Antony E Tobin
- The University of Melbourne, Melbourne Medical School, Department of Critical Care, Melbourne, Victoria, Australia.,Department of Intensive Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Paul J Young
- Wellington Hospital, Intensive Care Unit, Wellington, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Adam M Deane
- The University of Melbourne, 2281, Centre for Integrated Critical Care , Melbourne, Victoria, Australia.,Royal Melbourne Hospital, 90134, Intensive Care Unit, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, 90134, Department of Medicine, Melbourne, Victoria, Australia;
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9
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Maiden MJ, Fraser JD, Finnis ME. Venous blood for the analysis of acid–base status in a model of septic shock. Emerg Med Australas 2022; 34:456-458. [PMID: 35398968 PMCID: PMC9324208 DOI: 10.1111/1742-6723.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Acute Care Medicine The University of Adelaide Adelaide South Australia Australia
- Intensive Care Unit Barwon Health Geelong Victoria Australia
| | - Jonathan D Fraser
- Intensive Care Unit, Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Acute Care Medicine The University of Adelaide Adelaide South Australia Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Acute Care Medicine The University of Adelaide Adelaide South Australia Australia
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10
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Short-Burchell RJ, Corke CF, Carne RP, Orford NR, Maiden MJ. Documentation of neurological status in patients admitted to an intensive care unit after cardiac arrest: A 10-year cohort study. Aust Crit Care 2021; 35:557-563. [PMID: 34711494 DOI: 10.1016/j.aucc.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the documented neurological assessment and investigations for neuroprognostication in patients after cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study of adult patients after cardiac arrest, admitted to a tertiary intensive care unit (ICU), between January 2009 and December 2018. MAIN OUTCOME MEASURES The main outcome measures were the proportion of patients with a documented Glasgow Coma Scale (GCS) score and investigations for neuroprognostication. RESULTS Four hundred twenty-seven patients formed the study cohort. The GCS score was documented for 267 (63%) patients at some time during their ICU stay. The proportion of patients with the GCS score documented decreased each day of ICU stay (59% at day 1, 20% at day 5). Pupil reflex to light was recorded in 352 (82%), corneal reflex in 155 (36%), and limb reflexes in 216 (51%) patients. Twenty-eight (6.6%) patients underwent brain magnetic resonance imaging, 10 (2.3%) an electroencephalogram, and two somatosensory evoked potentials. Withdrawal of life-sustaining treatments occurred in 166 (39%) patients, and 221 (52%) patients died in hospital. CONCLUSIONS In this single-centre study of patients admitted to the ICU after cardiac arrest, the GCS score was inconsistently documented, and investigations for neuroprognostication were infrequent.
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Affiliation(s)
- Robert J Short-Burchell
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
| | - Charles F Corke
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Ross P Carne
- Department of Neurosciences, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Neil R Orford
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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11
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Low YM, Lyon CE, Lakey KM, Finnis ME, Orford NR, Maiden MJ. Frailty is not independently associated with intensive care unit length of stay: An observational study. Aust Crit Care 2021; 35:369-374. [PMID: 34462195 DOI: 10.1016/j.aucc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Frailty is independently associated with morbidity and mortality in critically ill patients. However, the association between preadmission frailty and the degree of treatment received in the intensive care unit (ICU) remains unclear. OBJECTIVE To describe patient length of stay in an ICU and the treatments provided according to the extent of patient frailty. METHODS Single-centre retrospective cohort study of adult patients admitted to a tertiary ICU between January 2018 and December 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). The primary outcome was ICU length of stay stratified by CFS score (1-8). Secondary outcomes were the proportion of patients with each CFS score treated with vasoactive agents, invasive ventilation, noninvasive ventilation, renal replacement therapy, and tracheostomy. Poisson regression and competing risks regression was used to analyse associations between ICU length of stay and potential confounders. RESULTS The study cohort comprised 2743 patients, with CFS scores known for 2272 (83%). Length of stay in the ICU increased with each increment in the CFS up to a score of 5, beyond which it decreased with higher frailty scores. After adjusting for age, illness severity, admission type, and treatment limitation, CFS scores were not independently associated with length of stay in the ICU (P = 0.31). The proportion of patients receiving specific ICU treatments peaked at different CFS scores, being highest for vasoactive agents at CFS 5 (47%), invasive ventilation CFS 3 (51%), noninvasive ventilation CFS 6 (11%), renal replacement therapy CFS 6 (8.2%), and tracheostomy CFS 5 (2.2%). Increasing frailty was associated with increased mortality and discharge to a destination other than home. CONCLUSIONS The extent of frailty is not independently associated with length of stay in the ICU. The proportion of patients receiving specific ICU treatments peaked at different CFS scores.
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Affiliation(s)
- Yvette M Low
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Victoria, Australia.
| | - Clare E Lyon
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Victoria, Australia
| | - Kylie M Lakey
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Victoria, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia; Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia
| | - Neil R Orford
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Victoria, Australia; Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia; Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia.
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12
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Deane AM, Jiang A, Tascone B, Clancy A, Finnis ME, Collie JT, Greaves R, Byrne KM, Fujii T, Douglas JS, Nichol A, Udy AA, Young M, Russo G, Fetterplace K, Maiden MJ, Plummer MP, Yanase F, Bellomo R, Ali Abdelhamid Y. A multicenter randomized clinical trial of pharmacological vitamin B1 administration to critically ill patients who develop hypophosphatemia during enteral nutrition (The THIAMINE 4 HYPOPHOSPHATEMIA trial). Clin Nutr 2021; 40:5047-5052. [PMID: 34388414 DOI: 10.1016/j.clnu.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypophosphatemia may be a useful biomarker to identify thiamine deficiency in critically ill enterally-fed patients. The objective was to determine whether intravenous thiamine affects blood lactate, biochemical and clinical outcomes in this group. METHOD This randomized clinical trial was conducted across 5 Intensive Care Units. Ninety critically ill adult patients with a serum phosphate ≤0.65 mmol/L within 72 h of commencing enteral nutrition were randomized to intravenous thiamine (200 mg every 12 h for up to 14 doses) or usual care (control). The primary outcome was blood lactate over time and data are median [IQR] unless specified. RESULTS Baseline variables were well balanced (thiamine: lactate 1.2 [1.0, 1.6] mmol/L, phosphate 0.56 [0.44, 0.64] mmol/L vs. control: lactate 1.0 [0.8, 1.3], phosphate 0.54 [0.44, 0.61]). Patients randomized to the intervention received a median of 11 [7.5, 13.5] doses for a total of 2200 [1500, 2700] mg of thiamine. Blood lactate over the entire 7 days of treatment was similar between groups (mean difference = -0.1 (95 % CI -0.2 to 0.1) mmol/L; P = 0.55). The percentage change from lactate pre-randomization to T = 24 h was not statistically different (thiamine: -32 (-39, -26) vs. control: -24 (-31, -16) percent, P = 0.09). Clinical outcomes were not statistically different (days of vasopressor administration: thiamine 2 [1, 4] vs. control 2 [0, 5.5] days; P = 0.37, and deaths 9 (21 %) vs. 5 (11 %); P = 0.25). CONCLUSIONS In critically ill enterally-fed patients who developed hypophosphatemia, intravenous thiamine did not cause measurable differences in blood lactate or clinical outcomes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12619000121167).
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Affiliation(s)
- Adam M Deane
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia.
| | - Alice Jiang
- Monash University, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Brianna Tascone
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Annabelle Clancy
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Mark E Finnis
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Monash University, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The University of Adelaide, Discipline of Acute Care Medicine, Adelaide, Australia
| | - Jake T Collie
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Australia
| | - Ronda Greaves
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kathleen M Byrne
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Tomoko Fujii
- Monash University, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - James S Douglas
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Alistair Nichol
- Monash University, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Australia
| | - Andrew A Udy
- Monash University, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Australia
| | - Meredith Young
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Australia
| | - Giovanni Russo
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fetterplace
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Matthew J Maiden
- The University of Adelaide, Discipline of Acute Care Medicine, Adelaide, Australia; Intensive Care Unit, Barwon Health, Geelong, Australia
| | - Mark P Plummer
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Yasmine Ali Abdelhamid
- The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Australia; Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
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13
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Wong HZ, Brusseleers M, Hall KA, Maiden MJ, Chapple LAS, Chapman MJ, Hodgson CL, Gluck S. Mixed-mode versus paper surveys for patient-reported outcomes after critical illness: A randomised controlled trial. Aust Crit Care 2021; 35:286-293. [PMID: 34176735 DOI: 10.1016/j.aucc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine the response rate to a mixed-mode survey using email compared with that to a paper survey in survivors of critical illness. DESIGN This is a prospective randomised controlled trial. SETTING The study was conducted at a single-centre quaternary intensive care unit (ICU) in Adelaide, Australia. PARTICIPANTS Study participants were patients admitted to the ICU for ≥48 h and discharged from the hospital. INTERVENTIONS The participants were randomised to receive a survey by paper (via mail) or via online (via email, or if a non-email user, via a letter with a website address). Patients who did not respond to the initial survey received a reminder paper survey after 14 days. The survey included quality of life (EuroQol-5D-5L), anxiety and depression (Hospital Anxiety and Depression Scale), and post-traumatic symptom (Impact of Event Scale-Revised) assessment. MAIN OUTCOME MEASURES Survey response rate, extent of survey completion, clinical outcomes at different time points after discharge, and survey cost analysis were the main outcome measures. Outcomes were stratified based on follow-up time after ICU discharge (3, 6, and 12 months). RESULTS A total of 239 patients were randomised. The response rate was similar between the groups (mixed-mode: 78% [92/118 patients] vs. paper: 80% [97/121 patients], p = 0.751) and did not differ between time points of follow-up. Incomplete surveys were more prevalent in the paper group (10% vs 18%). The median EuroQol-5D-5L index value was 0.83 [0.71-0.92]. Depressive symptoms were reported by 25% of patients (46/187), anxiety symptoms were reported by 27% (50/187), and probable post-traumatic stress disorder was reported by 14% (25/184). Patient outcomes did not differ between the groups or time points of follow-up. The cost per reply was AU$ 16.60 (mixed-mode) vs AU$ 19.78 (paper). CONCLUSION The response rate of a mixed-mode survey is similar to that of a paper survey and may provide modest cost savings.
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Affiliation(s)
- Hao Z Wong
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | | | - Kelly A Hall
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
| | - Matthew J Maiden
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Intensive Care Unit, Barwon Health, Geelong, Victoria, Australia; School of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Marianne J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Carol L Hodgson
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Samuel Gluck
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
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14
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Maiden MJ, Trisno R, Finnis ME, Norrish CM, Mulvey A, Nasr-Esfahani S, Orford NR, Moylan S. Long-term outcomes of patients admitted to an intensive care unit with intentional self-harm. Anaesth Intensive Care 2021; 49:173-182. [PMID: 33853393 DOI: 10.1177/0310057x20978987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-harm is one of the most common reasons for admission to an intensive care unit (ICU). While most patients with self-harm survive the ICU admission, little is known about their outcomes after hospital discharge. We conducted a retrospective cohort study of patients in the Barwon region in Victoria admitted to the ICU with self-harm (between 1998 and 2018) who survived to hospital discharge. The primary objective was to determine mortality after hospital discharge, and secondarily estimate relative survival, years of potential life lost, cause of death and factors associated with death. Over the 20-year study period, there were 710 patients in the cohort. The median patient age was 37 years (interquartile range (IQR) 26-48 years). A total of 406 (57%) were female, and 527 (74%) had a prior psychiatric diagnosis. The incidence of ICU admission increased over time (incidence rate ratio 1.05; 95% confidence interval (CI) 1.03-1.06 per annum). There were 105 (15%) patients who died after hospital discharge. Relative survival decreased each year after discharge, with the greatest decrement during the first 12 months. At ten years, relative survival was 0.85 (95% CI 0.81-0.88). The median years of potential life lost was 35 (IQR 22-45). Cause of death was self-harm in 27%, possible self-harm in 32% and medical disease in 41%. The only factors associated with mortality were male sex, older age and re-admission to ICU with self-harm. Further population studies are required to confirm these findings, and to understand what interventions may improve long-term survival in this relatively young group of critically ill patients.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Roth Trisno
- Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Anne Mulvey
- Intensive Care Unit, Barwon Health, Geelong, Australia
| | | | - Neil R Orford
- Intensive Care Unit, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steven Moylan
- Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia
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15
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Elderkin T, Bone A, Orford NR, Maiden MJ. Patients with pre-existing life-limiting illness in the intensive care unit: a point prevalence study. CRIT CARE RESUSC 2020; 22:285-286. [PMID: 32900339 PMCID: PMC10692545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tania Elderkin
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
| | - Allison Bone
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
| | - Neil R Orford
- Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
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16
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Ojha M, Finnis ME, Heckelmann M, Raith EP, Moodie S, Chapman MJ, Reddi B, Maiden MJ. Outcomes following grade V subarachnoid haemorrhage: A single-centre retrospective study. Anaesth Intensive Care 2020; 48:289-296. [PMID: 32659113 DOI: 10.1177/0310057x20927033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
SummaryGrade V subarachnoid haemorrhage is associated with high mortality and morbidity, yet there are few contemporary reports on the treatment provided and outcomes of these patients. In this single-centre retrospective cohort study, we primarily sought to determine the 12-month mortality of patients admitted to the Royal Adelaide Hospital intensive care unit between 2006 and 2016 with grade V subarachnoid haemorrhage. Secondary objectives were to describe treatments provided, patient destination following hospital discharge, organ donation and hospital financial costs. Over the 11-year study period, there were 139 patients admitted with grade V subarachnoid haemorrhage. The annual number of admissions did not change over time. The median age was 56 (interquartile range 48-70) years, 88 (63%) were female and 77 (55%) had a procedure to isolate an aneurysm. There were 77 (55%) patients who died in the intensive care unit, 87 (63%) died in hospital and 89 (64%) had died at 12 months. Of the 52 patients who survived to hospital discharge, 33 (63%) were transferred to a rehabilitation facility, 17 (33%) to another acute care hospital and two (4%) were discharged. Of the 87 patients who died in hospital, 45 (52%) donated organs. The total hospital cost of managing this cohort was A$8.3 million, with a median cost of A$41,824 (interquartile range A$9,933-A$97,332) per patient. Grade V subarachnoid haemorrhage has a high mortality rate, with one-third of patients alive after one year.
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Affiliation(s)
- Minny Ojha
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Heckelmann
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Eamon P Raith
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stewart Moodie
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Donate Life SA, Australia
| | - Marianne J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, Australia.,Intensive Care Unit, Barwon Health, Geelong, Australia
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Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Biradar V, Doherty S, Eastwood G, Finfer S, French CJ, Ghosh A, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM. Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial. CRIT CARE RESUSC 2020; 22:133-141. [PMID: 32389105 PMCID: PMC10692470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes. OBJECTIVE To detail the protocol, analysis and reporting plans for a randomised clinical trial - the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial - which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0-14.0 mmol/L) or usual care (target 6.0-10.0 mmol/L). MAIN OUTCOME MEASURES The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes. RESULTS AND CONCLUSION The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised. TRIAL REGISTRATION This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.
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Affiliation(s)
- Alexis P Poole
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Mark E Finnis
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Shailesh Bihari
- Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - Vishwanath Biradar
- Department of Intensive Care, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Sarah Doherty
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig J French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Angaj Ghosh
- Intensive Care Unit, Northern Health, Melbourne, VIC, Australia
| | - Simon Heller
- Clinical Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Peter S Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Matthew J Maiden
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Johan Mårtensson
- Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Shay P McGuinness
- Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Auckland District Health Board, Auckland, New Zealand
| | - Paul J Secombe
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Antony E Tobin
- Department of Intensive Care, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Andrew A Udy
- Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Adam M Deane
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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18
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Poole AP, Finnis ME, Anstey J, Bellomo R, Bihari S, Biradar V, Doherty S, Eastwood G, Finfer S, French CJ, Ghosh A, Heller S, Horowitz M, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Young PJ, Deane AM. Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial. CRIT CARE RESUSC 2020. [DOI: 10.51893/2020.2.oa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes. OBJECTIVE: To detail the protocol, analysis and reporting plans for a randomised clinical trial — the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial — which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0–14.0 mmol/L) or usual care (target 6.0–10.0 mmol/L). MAIN OUTCOME MEASURES: The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes. RESULTS AND CONCLUSION: The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised. TRIAL REGISTRATION: This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.
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Maiden MJ, Finnis ME, Duke GJ, Huning E, Crozier T, Nguyen N, Biradar V, McArthur C, Pilcher D. Obstetric admissions to intensive care units in Australia and New Zealand: a registry-based cohort study. BJOG 2020; 127:1558-1567. [PMID: 32359206 DOI: 10.1111/1471-0528.16285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Describe the epidemiology of obstetric patients admitted to an Intensive Care Unit (ICU). DESIGN Registry-based cohort study. SETTING One hundred and eighty-three ICUs in Australia and New Zealand. POPULATION Women aged 15-49 years, admitted to ICU between 2008 and 2017, classified as pregnant, postpartum or with an obstetric-related diagnosis. METHODS Data were extracted from the Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and national agencies. MAIN OUTCOME MEASURES Incidence of ICU admission, cohort characteristics, maternal outcomes and changes over time. RESULTS The cohort comprised 16 063 patients. The annual number of obstetric ICU admissions increased, whereas their proportion of total ICU admissions (1.3%) did not change (odds ratio 1.02, 95% CI 0.99-1.04, P = 0.14). There were 10 518 (65%) with an obstetric-related ICU diagnosis, and 5545 (35%) with a non-obstetric ICU diagnosis. Mean (SD) age was 31 (6.4) years, 1463 (9.1%) were Indigenous, 2305 (14%) were transferred from another hospital, and 3008 (19%) received mechanical ventilation. Median [IQR] length of stay in hospital was 5.2 [3.1-7.9] days, which included 1.1 [0.7-1.8] days in ICU. There were 108 (0.7%) maternal deaths, most (n = 97, 90%) having a non-obstetric diagnosis. There was no change in risk-adjusted length of stay or mortality over time. CONCLUSIONS Obstetric patients account for a stable proportion of ICU admissions in Australia and New Zealand. These patients typically have a short length of ICU stay and low hospital mortality. TWEETABLE ABSTRACT Obstetric patients in Australia/New Zealand ICUs have a short length of ICU stay and low mortality.
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Affiliation(s)
- M J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Vic., Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - M E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - G J Duke
- Intensive Care Service, Eastern Health, Box Hill Hospital, Box Hill, Vic., Australia.,Eastern Health Clinical School, Monash University, Clayton, Vic., Australia
| | - Eys Huning
- Department of Obstetrics & Gynaecology, Barwon Health, Geelong, Vic., Australia
| | - Tme Crozier
- Intensive Care Service, Eastern Health, Box Hill Hospital, Box Hill, Vic., Australia.,Eastern Health Clinical School, Monash University, Clayton, Vic., Australia.,Intensive Care Unit, Monash Medical Centre, Monash Health, Clayton, Vic., Australia.,Department of Obstetrics & Gynaecology, Monash University, Monash Medical Centre, Clayton, Vic., Australia
| | - N Nguyen
- Intensive Care Unit, Nepean Hospital, Penrith, NSW, Australia
| | - V Biradar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.,Intensive Care Unit, The Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - C McArthur
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - D Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.,Department of Intensive Care, Alfred Health, Prahran, Vic., Australia.,Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Camberwell, Vic., Australia
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20
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Maiden MJ, Cameron PA, Rosenfeld JV, Cooper DJ, McLellan S, Gabbe BJ. Long-Term Outcomes after Severe Traumatic Brain Injury in Older Adults. A Registry-based Cohort Study. Am J Respir Crit Care Med 2020; 201:167-177. [PMID: 31657946 DOI: 10.1164/rccm.201903-0673oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Rationale: Older adults (≥65 yr old) account for an increasing proportion of patients with severe traumatic brain injury (TBI), yet clinical trials and outcome studies contain relatively few of these patients.Objectives: To determine functional status 6 months after severe TBI in older adults, changes in this status over 2 years, and outcome covariates.Methods: This was a registry-based cohort study of older adults who were admitted to hospitals in Victoria, Australia, between 2007 and 2016 with severe TBI. Functional status was assessed with Glasgow Outcome Scale Extended (GOSE) 6, 12, and 24 months after injury. Cohort subgroups were defined by admission to an ICU. Features associated with functional outcome were assessed from the ICU subgroup.Measurements and Main Results: The study included 540 older adults who had been hospitalized with severe TBI over the 10-year period; 428 (79%) patients died in hospital, and 456 (84%) died 6 months after injury. There were 277 patients who had not been admitted to an ICU; at 6 months, 268 (97%) had died, 8 (3%) were dependent (GOSE 2-4), and 1 (0.4%) was functionally independent (GOSE 5-8). There were 263 patients who had been admitted to an ICU; at 6 months, 188 (73%) had died, 39 (15%) were dependent, and 32 (12%) were functionally independent. These proportions did not change over longer follow-up. The only clinical features associated with a lower rate of functional independence were Injury Severity Score ≥25 (adjusted odds ratio, 0.24 [95% confidence interval, 0.09-0.67]; P = 0.007) and older age groups (P = 0.017).Conclusions: Severe TBI in older adults is a condition with very high mortality, and few recover to functional independence.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre.,School of Public Health and Preventive Medicine and
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, and.,Department of Surgery, Monash University, Melbourne, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
| | - D James Cooper
- Intensive Care Unit, The Alfred Hospital, Prahran, Australia.,School of Public Health and Preventive Medicine and
| | | | - Belinda J Gabbe
- School of Public Health and Preventive Medicine and.,Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
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21
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Duke GJ, Maiden MJ, Huning EYS, Crozier TM, Bilgrami I, Ghanpur RB. Severe acute maternal morbidity trends in Victoria, 2001-2017. Aust N Z J Obstet Gynaecol 2019; 60:548-554. [PMID: 31788786 DOI: 10.1111/ajo.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/16/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of severe acute maternal morbidity (SAMM) is one method of measuring the complexity of maternal health and monitoring maternal outcomes. Monitoring trends may provide a quantitative method for assessing health care at local, regional, or jurisdictional levels and identify issues for further investigation. AIMS Identify temporal trends for SAMM event rates and maternal outcomes over 17 years in the state of Victoria, Australia. MATERIALS AND METHODS All maternal public health service admissions were extracted from an administrative dataset from July 2000 to June 2017. SAMM-related diagnoses were defined by matching as closely as possible with published definitions. Outcomes included annual SAMM event rates, hospital survival, and hospital length of stay (LOS). Temporal trends were analysed using mixed-effects generalised linear models. RESULTS There were 854 777 live births and 1.21 million pregnancy-related hospital admissions which included 34 008 SAMM events in 29 273 records and in 3.42% (95%CI = 3.39-3.46) of births. Most common were severe pre-eclampsia (0.87% of births), severe postpartum haemorrhage (0.59%), and sepsis (0.62%). SAMM-related admissions were associated with longer LOS and higher mortality risk (P < 0.001). Maternal mortality ratio remained unchanged at 8.6 fatalities per 100 000 births (P = 0.65). CONCLUSION Over 17 years, there was a significant increase in birth rate and SAMM-related events in Victoria. Administrative data may provide a pragmatic approach for monitoring SAMM-related events in maternal health services.
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Affiliation(s)
- Graeme J Duke
- Eastern Health Intensive Care Service, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Department, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Y S Huning
- Obstetrics & Gynaecology Service, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Tim M Crozier
- Intensive Care Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Irma Bilgrami
- Intensive Care Department, Western Health, Melbourne, Victoria, Australia
| | - Rashmi B Ghanpur
- Intensive Care Department, Warringal Hospital, Melbourne, Victoria, Australia
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22
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Abstract
Thyroid hormone is integral for normal function, yet during illness, circulating levels of the most active form (triiodothyronine [T3]) decline. Whether this is an adaptive response in critical illness or contributes to progressive disease has remained controversial. This review outlines the basis of thyroid hormone changes during critical illness and considers the evidence regarding T3 replacement.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia; Intensive Care Unit, Barwon Health, Ryrie St, Geelong, Victoria 3220, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
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23
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McCaffrey J, Maiden MJ, Norrish C. In-hospital cardiac arrests: events worth monitoring? CRIT CARE RESUSC 2018; 20:320. [PMID: 30482140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Joe McCaffrey
- Intensive Care Unit, University Hospital of Geelong, Geelong, Vic, Australia.
| | - Matthew J Maiden
- Intensive Care Unit, University Hospital of Geelong, Geelong, Vic, Australia
| | - Cathy Norrish
- Intensive Care Unit, University Hospital of Geelong, Geelong, Vic, Australia
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Poole AP, Anstey J, Bellomo R, Biradar V, Deane AM, Finfer SR, Finnis ME, French CJ, Kar P, Kruger PS, Maiden MJ, Mårtensson J, McArthur CJ, McGuinness SP, Secombe PJ, Tobin AE, Udy AA, Eastwood GM. Opinions and practices of blood glucose control in critically ill patients with pre-existing type 2 diabetes in Australian and New Zealand intensive care units. Aust Crit Care 2018; 32:361-365. [PMID: 30348487 DOI: 10.1016/j.aucc.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Approximately 9000 patients with type-2 diabetes mellitus (T2DM) are admitted to an intensive care unit (ICU) in Australia and New Zealand annually. For these patients, recent exploratory data suggest that targeting a more liberal blood glucose range during ICU admission may be safe and potentially beneficial. However, the current approach to blood glucose management of patients with T2DM in Australia and New Zealand ICUs is not well described, and there is uncertainty about clinician equipoise for trials of liberal glycaemic control in these patients. AIM The aim is to describe self-reported blood glucose management in patients with T2DM by intensivists working in Australian and New Zealand ICUs and to establish whether equipoise exists for a trial of liberal versus standard glycaemic control in such patients. METHOD An online questionnaire of Australia and New Zealand intensivists conducted in July-September 2016. RESULTS Seventy-one intensivists responded. Forty-five (63%) used a basic nomogram to titrate insulin. Sixty-six (93%) reported that insulin was commenced at blood glucose concentrations >10 mmol/L and titrated to achieve a blood glucose concentration between 6.0 and 10.0 mmol/L. A majority of respondents (75%) indicated that there was insufficient evidence to define optimal blood glucose targets in patients with T2DM, and 59 (83%) were prepared to enrol such patients in a clinical trial to evaluate a more liberal approach. CONCLUSION A majority of respondents were uncertain about the optimal blood glucose target range for patients with T2DM and would enrol such patients in a comparative trial of conventional versus liberal blood glucose control.
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Affiliation(s)
- Alexis P Poole
- Discipline of Acute Care Medicine, University of Adelaide, Australia; Department of Intensive Care, Royal Adelaide Hospital, Australia.
| | - James Anstey
- Department of Intensive Care, Royal Melbourne Hospital, Australia
| | | | | | - Adam M Deane
- Department of Intensive Care, Royal Melbourne Hospital, Australia
| | - Simon R Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark E Finnis
- Department of Intensive Care, Royal Adelaide Hospital, Australia
| | | | - Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Australia; Department of Intensive Care, Royal Adelaide Hospital, Australia
| | - Peter S Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Australia; School of Medicine, University of Queensland, Australia
| | | | | | - Colin J McArthur
- Department of Critical Care Medicine, Auckland District Health Board, Australia
| | - Shay P McGuinness
- Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Auckland District Health Board, Australia
| | - Paul J Secombe
- Department of Intensive Care, Alice Springs Hospital, Australia
| | - Antony E Tobin
- Department of Intensive Care, St Vincent's Hospital, Melbourne, Australia
| | - Andrew A Udy
- Department of Intensive Care, The Alfred Hospital, Australia
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25
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Maiden MJ, Finnis ME, Peake S, McRae S, Delaney A, Bailey M, Bellomo R. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial. Crit Care 2018; 22:118. [PMID: 29724246 PMCID: PMC5934793 DOI: 10.1186/s13054-018-2029-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intravenous fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of intravenous fluids administered during resuscitation from septic shock. METHODS We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of intravenous fluids administered over 6, 24 and 72 h using univariate and multivariate analysis. RESULTS Median (IQR) haemoglobin concentration at baseline was 133 (118-146) g/L and decreased to 115 (102-127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99-122) g/L after 24 h, and 109 (97-121) g/L after 72 h. At the corresponding time points, the cumulative volume of intravenous fluid administered was 1.3 (0.7-2.2) L, 2.9 (1.8-4.3) L and 4.6 (2.7-7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with intravenous fluid volume at each time point (R2 < 20%, P < 0.001). After adjusting for covariates, each litre of intravenous fluid administered was associated with a change in haemoglobin concentration of - 1.0 g/L (95% CI -1.5 to -0.6, P < 0.001) at 24 h and - 1.3 g/L (- 1.6 to - 0.9, P < 0.001) at 72 h. CONCLUSIONS Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, PO Pox 281, Geelong, Victoria, Australia. .,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia. .,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Sandra Peake
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.,Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia
| | - Simon McRae
- Department of Haematology, SA Pathology, Adelaide, South Australia, Australia
| | - Anthony Delaney
- Intensive Care Unit, Royal North Shore Hospital, St Leonard's, New South Wales, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Clayton, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,Critical Care Services, Monash Health, Clayton, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Melbourne, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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26
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Maiden MJ, Otto S, Brealey JK, Finnis ME, Chapman MJ, Kuchel TR, Nash CH, Edwards J, Bellomo R. Structure and Function of the Kidney in Septic Shock. A Prospective Controlled Experimental Study. Am J Respir Crit Care Med 2017; 194:692-700. [PMID: 26967568 DOI: 10.1164/rccm.201511-2285oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE It is unclear how septic shock causes acute kidney injury (AKI) and whether this is associated with histological change. OBJECTIVES We aimed to determine the nature and extent of changes in renal structure and function over time in an ovine model of septic shock. METHODS Fifteen sheep were instrumented with a renal artery flow probe and renal vein cannula. Ten were given intravenous Escherichia coli to induce septic shock, and five acted as controls. Animals were mechanically ventilated for 48 hours, while receiving protocol-guided parenteral fluids and a norepinephrine infusion to maintain mean arterial pressure. Renal biopsies were taken every 24 hours or whenever animals were oliguric for 2 hours. A renal pathologist, blinded to tissue source, systematically quantified histological appearance by light and electron microscopy for 31 prespecified structural changes. MEASUREMENTS AND MAIN RESULTS Sheep given E. coli developed septic shock, oliguria, increased serum creatinine, and reduced creatinine clearance (AKI), but there were no changes over time in renal blood flow between groups (P > 0.30) or over time within groups (P > 0.50). Renal oxygen consumption increased only in nonseptic animals (P = 0.01), but there was no between-group difference in renal lactate flux (P > 0.50). There was little structural disturbance in all biopsies and, although some cellular appearances changed over time, the only difference between septic and nonseptic animals was mesangial expansion on electron microscopy. CONCLUSIONS In an intensive care-supported model of gram-negative septic shock, early AKI was not associated with changes in renal blood flow, oxygen delivery, or histological appearance. Other mechanisms must contribute to septic AKI.
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Affiliation(s)
- Matthew J Maiden
- 1 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Sophia Otto
- 3 Department of Pathology, SA Pathology, Adelaide, Australia
| | - John K Brealey
- 3 Department of Pathology, SA Pathology, Adelaide, Australia
| | - Mark E Finnis
- 1 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Marianne J Chapman
- 1 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Tim R Kuchel
- 4 Preclinical, Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains, Australia; and
| | - Coralie H Nash
- 2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Jason Edwards
- 1 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
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27
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Maiden MJ, Otto S, Brearly J, Chapman MJ, Nash CH, Edwards J, Kuchel TR, Bellomo R. Structure and function of the kidney in septic shock - a prospective controlled study. Intensive Care Med Exp 2015. [PMCID: PMC4797103 DOI: 10.1186/2197-425x-3-s1-a838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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28
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Maiden MJ, White J. Severe rapid-onset paralysis in a part-time soldier. CRIT CARE RESUSC 2006; 8:120-2. [PMID: 16749878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We report a case of severe rapid-onset paralysis in a 28- year-old previously healthy man, necessitating intubation and mechanical ventilation, after a presumed bite or sting. Despite no other systemic manifestations of envenoming, the paralysis rapidly responded to polyvalent snake antivenom. The rapidity and severity of clinical effects make this case most concerning. We outline a differential diagnosis of acute paralysis and comment on issues relating to the management of the envenomed patient.
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Affiliation(s)
- Matthew J Maiden
- Mediflight Critical Care Retrieval Service, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Maiden MJ, Benton GN, Bourne RA. Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomised controlled trial. Med J Aust 2003; 178:433-6. [PMID: 12720508 DOI: 10.5694/j.1326-5377.2003.tb05284.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2002] [Accepted: 03/11/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether warming or rubbing adult diphtheria tetanus (ADT) vaccine immediately before administration affects its temperature and reduces the incidence of pain. DESIGN Double-blind, randomised controlled trial and in-vitro temperature study. SETTING Emergency department (ED) of a regional hospital between April and December 2001. PATIENTS Convenience sample of 150 patients aged 16 years or over who presented to the ED requiring ADT booster vaccination. INTERVENTION Patients were randomised to receive vaccine that was "cold" (no deliberate warming), "rubbed" between the palms for 1 minute, or "warmed" in a 37 degrees C incubator; vaccine was administered as recommended in Australian guidelines. MAIN OUTCOME MEASURES Incidence of pain and pain score on McGill Present Pain Intensity Questionnaire at 5 minutes, 24 hours and 48 hours after injection; and temperature of vaccine after preparation for simulated administration. RESULTS The "cold" vaccine had significantly lower temperature (mean, 19.1 degrees C; 95% CI, 17.5-20.7 degrees C) than the "warmed" vaccine (mean, 28.9 degrees C; 95% CI, 28.4-29.4 degrees C) and "rubbed" vaccine (mean, 26.9 degrees C; 95% CI, 24.5-29.3 degrees C). There was no significant difference in incidence of pain between the groups who received vaccine prepared in different ways at any follow-up (5 min: P = 0.62; 24 h: P = 0.58; 48 h: P = 0.61) or overall (P = 0.99). Among those who completed follow-up, incidence of pain at any time was 77/138 (56%); there was no difference in their time-averaged pain scores (P = 0.63) or peak pain scores (P = 0.60). CONCLUSIONS Warming or rubbing ADT vaccine does not reduce the incidence of pain after administration. Regardless of how ADT vaccine is prepared, its temperature approaches ambient by the time it is injected.
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Affiliation(s)
- Matthew J Maiden
- Department of Emergency Medicine, Wangaratta District Base Hospital, Green Street, Wangaratta, VIC 3677.
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