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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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Gruen RL, Mitra B, Bernard SA, McArthur CJ, Burns B, Gantner DC, Maegele M, Cameron PA, Dicker B, Forbes AB, Hurford S, Martin CA, Mazur SM, Medcalf RL, Murray LJ, Myles PS, Ng SJ, Pitt V, Rashford S, Reade MC, Swain AH, Trapani T, Young PJ. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med 2023; 389:127-136. [PMID: 37314244 DOI: 10.1056/nejmoa2215457] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain. METHODS We randomly assigned adults with major trauma who were at risk for trauma-induced coagulopathy to receive tranexamic acid (administered intravenously as a bolus dose of 1 g before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital) or matched placebo. The primary outcome was survival with a favorable functional outcome at 6 months after injury, as assessed with the use of the Glasgow Outcome Scale-Extended (GOS-E). Levels on the GOS-E range from 1 (death) to 8 ("upper good recovery" [no injury-related problems]). We defined survival with a favorable functional outcome as a GOS-E level of 5 ("lower moderate disability") or higher. Secondary outcomes included death from any cause within 28 days and within 6 months after injury. RESULTS A total of 1310 patients were recruited by 15 emergency medical services in Australia, New Zealand, and Germany. Of these patients, 661 were assigned to receive tranexamic acid, and 646 were assigned to receive placebo; the trial-group assignment was unknown for 3 patients. Survival with a favorable functional outcome at 6 months occurred in 307 of 572 patients (53.7%) in the tranexamic acid group and in 299 of 559 (53.5%) in the placebo group (risk ratio, 1.00; 95% confidence interval [CI], 0.90 to 1.12; P = 0.95). At 28 days after injury, 113 of 653 patients (17.3%) in the tranexamic acid group and 139 of 637 (21.8%) in the placebo group had died (risk ratio, 0.79; 95% CI, 0.63 to 0.99). By 6 months, 123 of 648 patients (19.0%) in the tranexamic acid group and 144 of 629 (22.9%) in the placebo group had died (risk ratio, 0.83; 95% CI, 0.67 to 1.03). The number of serious adverse events, including vascular occlusive events, did not differ meaningfully between the groups. CONCLUSIONS Among adults with major trauma and suspected trauma-induced coagulopathy who were being treated in advanced trauma systems, prehospital administration of tranexamic acid followed by an infusion over 8 hours did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. (Funded by the Australian National Health and Medical Research Council and others; PATCH-Trauma ClinicalTrials.gov number, NCT02187120.).
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Affiliation(s)
- Russell L Gruen
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Biswadev Mitra
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stephen A Bernard
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Colin J McArthur
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Brian Burns
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Dashiell C Gantner
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Marc Maegele
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Peter A Cameron
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Bridget Dicker
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Andrew B Forbes
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Sally Hurford
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Catherine A Martin
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stefan M Mazur
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Robert L Medcalf
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Lynnette J Murray
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Paul S Myles
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Sze J Ng
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Veronica Pitt
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stephen Rashford
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Michael C Reade
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Andrew H Swain
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Tony Trapani
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Paul J Young
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
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Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med 2022; 387:1747-1758. [PMID: 36286256 DOI: 10.1056/nejmoa2209083] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability. METHODS We randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilation to receive increased early mobilization (sedation minimization and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU). The primary outcome was the number of days that the patients were alive and out of the hospital at 180 days after randomization. RESULTS The median number of days that patients were alive and out of the hospital was 143 (interquartile range, 21 to 161) in the early-mobilization group and 145 days (interquartile range, 51 to 164) in the usual-care group (absolute difference, -2.0 days; 95% confidence interval [CI], -10 to 6; P = 0.62). The mean (±SD) daily duration of active mobilization was 20.8±14.6 minutes and 8.8±9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; 95% CI, 10.4 to 13.6). A total of 77% of the patients in both groups were able to stand by a median interval of 3 days and 5 days, respectively (difference, -2 days; 95% CI, -3.4 to -0.6). By day 180, death had occurred in 22.5% of the patients in the early-mobilization group and in 19.5% of those in the usual-care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups. Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group (P = 0.005). CONCLUSIONS Among adults undergoing mechanical ventilation in the ICU, an increase in early active mobilization did not result in a significantly greater number of days that patients were alive and out of the hospital than did the usual level of mobilization in the ICU. The intervention was associated with increased adverse events. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.).
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Affiliation(s)
- Carol L Hodgson
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Michael Bailey
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Rinaldo Bellomo
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Kathy Brickell
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Tessa Broadley
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Heidi Buhr
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Belinda J Gabbe
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Doug W Gould
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Meg Harrold
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Alisa M Higgins
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Sally Hurford
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Theodore J Iwashyna
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Ary Serpa Neto
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Alistair D Nichol
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Jeffrey J Presneill
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Stefan J Schaller
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Janani Sivasuthan
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Claire J Tipping
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Steven Webb
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Paul J Young
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [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] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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5
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Murthy TA, Bellomo R, Chapman MJ, Deane AM, Ferrie S, Finnis ME, Hurford S, O’Connor SN, Peake SL, Summers MJ, Williams PJ, Young PJ, Chapple LAS. Protein delivery in mechanically ventilated adults in Australia and New Zealand: current practice. CRIT CARE RESUSC 2021; 23:386-393. [PMID: 38046685 PMCID: PMC10692581 DOI: 10.51893/2021.4.oa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To quantify current protein prescription and delivery in critically ill adults in Australia and New Zealand and compare it with international guidelines. Design: Prospective, multicentre, observational study. Setting: Five intensive care units (ICUs) across Australia and New Zealand. Participants: Mechanically ventilated adults who were anticipated to receive enteral nutrition for ≥ 24 hours. Main outcome measures: Baseline demographic and nutrition data in ICU, including assessment of requirements, prescription and delivery of enteral nutrition, parenteral nutrition and protein supplementation, were collected. The primary outcome was enteral nutrition protein delivery (g/kg ideal body weight [IBW] per day). Data are reported as mean ± standard deviation or n (%). Results: 120 patients were studied (sex, 60% male; mean age, 59 ± 16 years; mean admission APACHE II score, 20 ± 8). Enteral nutrition was delivered on 88%, parenteral nutrition on 6.8%, and protein supplements on 0.3% of 1156 study days. For the 73% (88/120) of patients who had a nutritional assessment, the mean estimated protein requirements were 99 ± 22 g/day (1.46 ± 0.55 g/kg IBW per day). The mean daily protein delivery was 54 ± 23 g (0.85 ± 0.35 g/kg IBW per day) from enteral nutrition and 56 ± 23 g (0.88 ± 0.35 g/kg IBW per day) from all sources (enteral nutrition, parenteral nutrition, protein supplements). Protein delivery was ≥ 1.2 g/kg IBW per day on 29% of the total study days per patient. Conclusions: Protein delivery as a part of current usual care to critically ill adults in Australia and New Zealand remains below that recommended in international guidelines.
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Affiliation(s)
- Tejaswini Arunachala Murthy
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Marianne J. Chapman
- 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, Monash University, Melbourne, VIC, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
| | - Adam M. Deane
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Stephanie N. O’Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra L. Peake
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine,Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Matthew J. Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Patricia J. Williams
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine,Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Paul J. Young
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia
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Presneill JJ, Bellomo R, Brickell K, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna T, Neto AS, Nichol A, Schaller SJ, Sivasuthan J, Tipping C, Webb S, Young P, Hodgson CL. Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. CRIT CARE RESUSC 2021; 23:262-272. [PMID: 38046085 PMCID: PMC10692544 DOI: 10.51893/2021.3.oa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the protocol and statistical analysis plan for the Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. Design: An international, multicentre, parallel-group, randomised controlled phase 3 trial. Setting: Intensive care units (ICUs) in Australia, New Zealand, Germany, Ireland, the United Kingdom and Brazil. Patients: 750 adult patients expected to receive mechanical ventilation for more than 48 hours. Interventions: Early activity and mobilisation delivered to critically ill patients in an ICU for up to 28 days compared with standard care. Main outcome measures: The primary outcome is the number of days alive and out of hospital at 180 days after randomisation. Secondary outcomes include ICU-free days, ventilator-free days, delirium-free days, all-cause mortality at 28 and 180 days after randomisation, and functional outcome at 180 days after randomisation. Results: Recruitment at 46 research sites passed 576 patients in March 2021. Final collection of all 180-day outcome data for the target of 750 patients is anticipated by May 2022. Conclusions: Consistent with international guidelines, a detailed protocol and prospective analysis plan has been developed for the TEAM III trial. This plan specifies the statistical models for evaluating primary and secondary outcomes, defines covariates for adjusted analyses, and defines methods for exploratory analyses. Application of this protocol and statistical analysis plan to the forthcoming TEAM III trial will facilitate unbiased analyses of the clinical data collected. Trial registration:ClinicalTrials.gov identifier NCT03133377.
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Affiliation(s)
- Jeffrey J. Presneill
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Critical Care Department, Austin Hospital, Melbourne, VIC, Australia
| | - Kathy Brickell
- University College Dublin Clinical Research Centre, St Vincent’s University Hospital, Dublin, Ireland
| | - Heidi Buhr
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Doug W. Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Meg Harrold
- Curtin University, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Theodore Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- University College Dublin Clinical Research Centre, St Vincent’s University Hospital, Dublin, Ireland
| | - Stefan J. Schaller
- Department of Anesthesiology, Division of Operative Intensive Care Medicine, Charité — Universitätsmedizin Berlin, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Janani Sivasuthan
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Tipping
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Steven Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- St John of God Subiaco Hospital, Perth, WA, Australia
| | - Paul Young
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Carol L. Hodgson
- Department of Critical Care, University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - for the TEAM Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Critical Care Department, Austin Hospital, Melbourne, VIC, Australia
- University College Dublin Clinical Research Centre, St Vincent’s University Hospital, Dublin, Ireland
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Intensive Care National Audit and Research Centre, London, UK
- Curtin University, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Department of Anesthesiology, Division of Operative Intensive Care Medicine, Charité — Universitätsmedizin Berlin, Humboldt Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
- St John of God Subiaco Hospital, Perth, WA, Australia
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
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7
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Chapple LAS, Summers MJ, Bellomo R, Chapman MJ, Davies AR, Ferrie S, Finnis ME, Hurford S, Lange K, Little L, O'Connor SN, Peake SL, Ridley EJ, Young PJ, Williams PJ, Deane AM. Use of a High-Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel-Group, Feasibility Trial. JPEN J Parenter Enteral Nutr 2020; 45:699-709. [PMID: 33296079 DOI: 10.1002/jpen.2059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/13/2020] [Revised: 10/20/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND International guidelines recommend critically ill adults receive more protein than most receive. We aimed to establish the feasibility of a trial to evaluate whether feeding protein to international recommendations would improve outcomes, in which 1 group received protein doses representative of international guideline recommendations (high protein) and the other received doses similar to usual practice. METHODS We conducted a prospective, randomized, blinded, parallel-group, feasibility trial across 6 intensive care units. Critically ill, mechanically ventilated adults expected to receive enteral nutrition (EN) for ≥2 days were randomized to receive EN containing 63 or 100 g/L protein for ≤28 days. Data are mean (SD) or median (interquartile range). RESULTS The recruitment rate was 0.35 (0.13) patients per day, with 120 patients randomized and data available for 116 (n = 58 per group). Protein delivery was greater in the high-protein group (1.52 [0.52] vs 0.99 [0.27] grams of protein per kilogram of ideal body weight per day; difference, 0.53 [95% CI, 0.38-0.69] g/kg/d protein), with no difference in energy delivery (difference, -26 [95% CI, -190 to 137] kcal/kg/d). There were no between-group differences in the duration of feeding (8.7 [7.3] vs 8.1 [6.3] days), and blinding of the intervention was confirmed. There were no differences in clinical outcomes, including 90-day mortality (14/55 [26%] vs 15/56 [27%]; risk difference, -1.3% [95% CI, -17.7% to 15.0%]). CONCLUSION Conducting a multicenter blinded trial is feasible to compare protein delivery at international guideline-recommended levels with doses similar to usual care during critical illness.
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Affiliation(s)
- 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, Australia
| | - 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
| | - Rinaldo Bellomo
- Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia.,The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, 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, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew R Davies
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, 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
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kylie Lange
- National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, Monash University, 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
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - 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
| | - Adam M Deane
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia
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- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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8
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Baggott C, Chan A, Hurford S, Fingleton J, Beasley R, Harwood M, Reddel HK, Levack WMM. Patient preferences for asthma management: a qualitative study. BMJ Open 2020; 10:e037491. [PMID: 32801203 PMCID: PMC7430405 DOI: 10.1136/bmjopen-2020-037491] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/01/2020] [Accepted: 07/02/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Preference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients' attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences. DESIGN A qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups. SETTING Three locations within the greater Wellington area in New Zealand. PARTICIPANTS Twenty-seven adults with self-reported doctor's diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month. RESULTS Four key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management. CONCLUSIONS This study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000601134).
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Affiliation(s)
| | - Amy Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
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9
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Reid AL, Chapman MJ, Peake SL, Bellomo R, Davies A, Deane AM, Horowitz M, Hurford S, Lange K, Little L, Mackle D, O'Connor SN, Ridley EJ, Williams PJ, Young PJ. Energy-dense vs routine enteral nutrition in New Zealand Europeans, Māori, and Pacific Peoples who are critically ill. N Z Med J 2020; 133:72-82. [PMID: 32525863] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS To evaluate the effect of energy-dense vs routine enteral nutrition on day-90 mortality by ethnic group in critically ill adults. METHODS Pre-planned subgroup analysis of the 1,257 New Zealanders in a 4,000-participant randomised trial comparing energy-dense enteral nutrition (1.5kcal/mL) with routine enteral nutrition (1kcal/mL) in mechanically ventilated intensive care unit (ICU) patients. The primary purpose of this analysis was to evaluate responses to study treatment by ethnic group (European, Māori, and Pacific Peoples) using ethnicity data recorded in the clinical records. The secondary purpose was to compare the characteristics and outcomes of patients by ethnic group. The primary outcome was day-90 mortality. RESULTS Among 1,138 patients included in the primary outcome analysis, 165 of 569 (29.0%) assigned to energy-dense nutrition and 156 of 569 patients (27.4%) assigned to routine nutrition died by day 90 (odds ratio; 1.06; 95% CI, 0.92-1.22). There was no statistically significant interaction between treatment allocation and ethnicity with respect to day-90 mortality. Day-90 mortality rates did not vary statistically significantly by ethnic group. CONCLUSIONS Among mechanically ventilated adults in New Zealand ICUs, the effect on day-90 mortality of energy-dense vs routine enteral nutrition did not vary by ethnicity.
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Affiliation(s)
- Alice L Reid
- Research Fellow, Medical Research Institute of New Zealand, Wellington
| | - Marianne J Chapman
- Research Director, Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Professor, Faculty of Health and Medical Sciences, The University of Adelaide, SA, Australia; Adjunct Associate Professor, School of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Sandra L Peake
- Director, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville South, SA, Australia; Professor, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia; Adjunct Associate Professor, School of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Rinaldo Bellomo
- Intensive Care Specialist, Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
| | - Andrew Davies
- Intensive Care Specialist, Intensive Care Unit, Frankston, VIC, Australia
| | - Adam M Deane
- Principal Research Fellow, The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Michael Horowitz
- Professor of Medicine & Head Endocrine Unit, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Sally Hurford
- ICU Trials Project Manager, Medical Research Institute of New Zealand, Wellington
| | - Kylie Lange
- Biostatistician, Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, SA, Australia
| | - Lorraine Little
- Project Manager, School of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Diane Mackle
- ICU Programme Manager, Medical Research Institute of New Zealand, Wellington
| | - Stephanie N O'Connor
- ICU Clinical Research Manager, Royal Adelaide Hospital, Adelaide, SA, Australia; Affiliate Senior Lecturer, Acute Care Medicine, The University of Adelaide, SA, Australia
| | - Emma J Ridley
- Senior Research Fellow, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Patricia J Williams
- Research Coordinator, Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville South, SA, Australia; Affiliate Lecturer, Acute Care Medicine, The University of Adelaide, SA, Australia; Adjunct Research Fellow, Department of Epidemiology and Preventative Medicine, Monash University, VIC, Australia
| | - Paul J Young
- Deputy Director, Medical Research Institute of New Zealand, Wellington; Intensive Care Specialist, Wellington Hospital, Wellington
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10
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Deane AM, Little L, Bellomo R, Chapman MJ, Davies AR, Ferrie S, Horowitz M, Hurford S, Lange K, Litton E, Mackle D, O'Connor S, Parker J, Peake SL, Presneill JJ, Ridley EJ, Singh V, van Haren F, Williams P, Young P, Iwashyna TJ. Outcomes Six Months after Delivering 100% or 70% of Enteral Calorie Requirements during Critical Illness (TARGET). A Randomized Controlled Trial. Am J Respir Crit Care Med 2020; 201:814-822. [PMID: 31904995 DOI: 10.1164/rccm.201909-1810oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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] [Indexed: 02/07/2023] Open
Abstract
Rationale: The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared with a lesser amount of calories are unknown.Objectives: Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality-of-life scores, return to work, and key life activities and reduce death and disability 6 months later.Methods: We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3,957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition.Measurements and Main Results: Participants assigned energy-dense nutrition received more calories (percent recommended energy intake, mean [SD]; energy-dense: 103% [28] vs. usual: 69% [18]). Mortality at Day 180 was similar (560/1,895 [29.6%] vs. 539/1,920 [28.1%]; relative risk 1.05 [95% confidence interval, 0.95-1.16]). At a median (interquartile range) of 185 (182-193) days after randomization, 2,492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality-of-life questionnaire visual analog scale, median [interquartile range]: 75 [60-85]; group difference: 0 [95% confidence interval, 0-0]). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n = 818). There was no observed difference in disability (n = 1,208) or participation in key life activities (n = 705).Conclusions: The delivery of approximately 100% compared with 70% of recommended calorie intake during critical illness does not improve quality of life or functional outcomes or increase the number of survivors 6 months later.
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Affiliation(s)
- Adam M Deane
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital and
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | | | - Andrew R Davies
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzie Ferrie
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kylie Lange
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jeffrey J Presneill
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital and
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vanessa Singh
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Frank van Haren
- Medical School, Australian National University, Canberra, Australia; and
| | | | - Paul Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Shulman M, Cuthbertson B, Wijeysundera D, Pearse R, Thompson B, Torres E, Ambosta A, Wallace S, Farrington C, Myles P, Wallace S, Thompson B, Ellis M, Borg B, Kerridge R, Douglas J, Brannan J, Pretto J, Godsall M, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter T, Macklin S, Elliott A, Carrera A, Terblanche N, Pitt S, Samuels J, Wilde C, MacCormick A, Leslie K, Bramley D, Southcott A, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney C, Choi S, Somascanthan P, Flores K, Beattie W, Karkouti K, Clarke H, Jerath A, McCluskey S, Wasowicz M, Granton J, Day L, Pazmino-Canizares J, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, Mcallister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G, Melo M, Mamdani M, Hillis G, Wijeysundera H. Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111-119. [DOI: 10.1016/j.bja.2018.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
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Chapman M, Peake SL, Bellomo R, Davies A, Deane A, Horowitz M, Hurford S, Lange K, Little L, Mackle D, O’Connor S, Presneill J, Ridley E, Williams P, Young P. Energy-Dense versus Routine Enteral Nutrition in the Critically Ill. N Engl J Med 2018; 379:1823-1834. [PMID: 30346225 DOI: 10.1056/nejmoa1811687] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [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: 02/05/2023]
Abstract
BACKGROUND The effect of delivering nutrition at different calorie levels during critical illness is uncertain, and patients typically receive less than the recommended amount. METHODS We conducted a multicenter, double-blind, randomized trial, involving adults undergoing mechanical ventilation in 46 Australian and New Zealand intensive care units (ICUs), to evaluate energy-dense (1.5 kcal per milliliter) as compared with routine (1.0 kcal per milliliter) enteral nutrition at a dose of 1 ml per kilogram of ideal body weight per hour, commencing at or within 12 hours of the initiation of nutrition support and continuing for up to 28 days while the patient was in the ICU. The primary outcome was all-cause mortality within 90 days. RESULTS There were 3957 patients included in the modified intention-to-treat analysis (1971 in the 1.5-kcal group and 1986 in the 1.0-kcal group). The volume of enteral nutrition delivered during the trial was similar in the two groups; however, patients in the 1.5-kcal group received a mean (±SD) of 1863±478 kcal per day as compared with 1262±313 kcal per day in the 1.0-kcal group (mean difference, 601 kcal per day; 95% confidence interval [CI], 576 to 626). By day 90, a total of 523 of 1948 patients (26.8%) in the 1.5-kcal group and 505 of 1966 patients (25.7%) in the 1.0-kcal group had died (relative risk, 1.05; 95% CI, 0.94 to 1.16; P=0.41). The results were similar in seven predefined subgroups. Higher calorie delivery did not affect survival time, receipt of organ support, number of days alive and out of the ICU and hospital or free of organ support, or the incidence of infective complications or adverse events. CONCLUSIONS In patients undergoing mechanical ventilation, the rate of survival at 90 days associated with the use of an energy-dense formulation for enteral delivery of nutrition was not higher than that with routine enteral nutrition. (Funded by National Health and Medical Research Institute of Australia and the Health Research Council of New Zealand; TARGET ClinicalTrials.gov number, NCT02306746 .).
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Affiliation(s)
- Marianne Chapman
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Sandra L Peake
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Andrew Davies
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Adam Deane
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Michael Horowitz
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Sally Hurford
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Kylie Lange
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Diane Mackle
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Stephanie O’Connor
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Jeffrey Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Emma Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Patricia Williams
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
| | - Paul Young
- Australian and New Zealand Intensive Care Research Centre, Monash University (M.C., S.L.P., R.B., A. Davies, L.L., S.O., J.P., E.R., P.W.), Austin Hospital (R.B.), Frankston Hospital (A. Davies), Royal Melbourne Hospital (A. Deane, J.P.), University of Melbourne (A. Deane, J.P.), and Alfred Hospital (E.R.), Melbourne, VIC, and the University of Adelaide (M.C., S.L.P., A. Deane, M.H., K.L., S.O., P.W.), Queen Elizabeth Hospital (S.L.P., P.W.), Royal Adelaide Hospital (M.C., M.H., S.O.), and National Health and Medical Research Council Centre of Research Excellence in Translating Nutritional Science to Good Health (M.C., M.H., K.L.), Adelaide, SA — all in Australia; and Medical Research Institute of New Zealand (S.H., D.M., P.Y.) and Wellington Hospital (P.Y.), Wellington, New Zealand
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Psirides A, Hill J, Hurford S. A review of rapid response team activation parameters in New Zealand hospitals. Resuscitation 2013; 84:1040-4. [PMID: 23376581 DOI: 10.1016/j.resuscitation.2013.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 10/11/2012] [Revised: 12/19/2012] [Accepted: 01/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review current systems for recognising and responding to clinically deteriorating patients in all New Zealand public hospitals. DESIGN A cross-sectional study of recognition and response systems in all New Zealand public hospitals was conducted in October 2011. Copies of all current vital sign charts and/or relevant policies were requested. These were examined for vital sign based recognition and response systems. The charts or policies were also used to determine the type of system in use and the vital sign parameters and trigger thresholds that provoke a call to the rapid response team. SETTING All New Zealand District Health Boards (DHBs). MAIN OUTCOME MEASURES Physiological parameters used to trigger rapid response, the weighting of any early warning score assigned to them, type of system used, values of physiological derangement that trigger maximal system response. RESULTS All DHBs use aggregate scoring systems to assess deterioration and respond. A total of 9 different physiological parameters were scored with most charts (21%) scoring 6 different parameters. All scored respiratory rate, heart rate, systolic blood pressure and conscious level. 86% scored oliguria, 14% polyuria, 33% oxygen saturation and 24% oxygen administration. All systems used either aggregate scores or a single extreme parameter to elicit a maximal system response. The extremes of physiological derangement to which scores were assigned varied greatly with bradypnoea having the greatest range for what was considered grossly abnormal. CONCLUSION A large variance exists in the criteria used to detect deteriorating patients within New Zealand hospitals. Standardising both the vital signs chart and escalation criteria is likely to be of significant benefit in the early detection of and response to patient deterioration.
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Affiliation(s)
- Alex Psirides
- Intensive Care Specialist, Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
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Disler PB, Jacka E, Sayed AR, Rip MR, Hurford S, Collis P. The prevalence of locomotor disability and handicap in the Cape Peninsula. Part I. The coloured population of Bishop Lavis. S Afr Med J 1986; 69:349-52. [PMID: 2938278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A door-to-door survey to identify the locomotor disabled was carried out on 33.35% of the so-called coloured population in a low socio-economic area of the Cape Peninsula (9112 people). The prevalence rate of locomotor disability was 11.2/1000. The main causes of disability were illness (44.1%) and trauma (41.2%); the former resulted mostly from cerebrovascular accidents (15.7%) and poliomyelitis (15.7%). Of the disabled persons 11.8% were 15 years of age or less, 57.8% between the ages of 16 and 59 years and 30.4% were more than 60 years. Of those in the working-age group 15% were employed. Few of the unemployed had hobbies or interests or had any contact with health or social services.
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Disler PB, Jacka E, Sayed AR, Rip MR, Hurford S, Collis P. The prevalence of locomotor disability and handicap in the Cape Peninsula. Part II. The black population of Nyanga. S Afr Med J 1986; 69:353-5. [PMID: 2938279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A door-to-door survey to identify the locomotor-disabled was carried out on 8.5% of the population of a black residential area of the Cape Peninsula (2072 people). The prevalence rate of locomotor disability was 18.3/1000; causes of disability related to illness (36.8%), trauma (31.6%) and congenital factors (23.7%). The main illnesses described were cerebrovascular accidents (26.1%) and poliomyelitis (21.7%). Persons aged 15 years or less constituted 18,4% of the disabled, while 42.1% were aged 16-59 years and 39.5% 60 years or more. Although many of the disabled individuals identified could move about independently, the proportion bedridden was high (15.8%). At the time of the survey 13.3% of adults were working and 51.1% of children over 6 years old attended school. Eighty per cent had no contact with health services.
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Disler PB, Jacka E, Sayed AR, Rip MR, Hurford S, Collis P. The prevalence of locomotor disability and handicap in the Cape Peninsula. Part III. The white population of Fish Hoek. S Afr Med J 1986; 69:355-7. [PMID: 2938280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A door-to-door survey to identify the locomotor-disabled was carried out on 24.2% of the population living in a white middle-class residential area of the Cape Peninsula (2391 people). This coastal resort is a popular place for retirement and has a large elderly population (23.3%). The prevalence rate of locomotor disability was 13/1000. Illness caused 74.2% of the disability, and in 34.5% of cases this was identified as arthritis. Most of the disabled were aged 60 years or more (77.4%), while 22.6% were 16-59 years old. Fifty per cent of those in the working-age group were employed; one-third competed in the open labour market and the rest were in sheltered employment. Few people were in contact with health, geriatric or social services.
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