Critical Care and Resuscitation最新文献

{"title":"Evidence-based guidelines for the use of extracorporeal membrane oxygenation in Australia and New Zealand using GRADE methodology series part 1: Venovenous extracorporeal membrane oxygenation (VV ECMO) indications and management","authors":"Sally F. Newman BN, PGCert ,&nbsp;Aidan Burrell MBBS, PhD, FCICM ,&nbsp;Hergen Buscher DEAA, EDIC, FCICM ,&nbsp;Daniel Thomas Chung BMed, MD ,&nbsp;Paul Forrest MBChB, FANZCA ,&nbsp;John Fraser PhD, MBChB, FRCP, FCICM, FJFICM ,&nbsp;Craig French MBBS, FCICM ,&nbsp;Carol Hodgson PhD, FACP, FAHMS ,&nbsp;Ryan Ruiyang Ling MBBS ,&nbsp;Ed Litton MBChB, FCICM, MSc, PhD ,&nbsp;Graeme MacLaren MBBS, MSc FCICM ,&nbsp;Andrew McKee MBChB, FANZCA, FJFICM ,&nbsp;Zachary Munn PhD, GradDip HlthSc, BMedRad ,&nbsp;Nhi Nguyen B Med Sci FCICM ,&nbsp;Julia K. Pilowski RN, PhD ,&nbsp;Kollengode Ramanathan MD, FCICM ,&nbsp;Mark Sackley ,&nbsp;Kiran Shekar MBBS, PhD, FCICM, FCCM ,&nbsp;Myles Smith MBBS, MBiostat, EDIC, FCICM ,&nbsp;Nikki Stamp MBBS (Hons), FRACS ,&nbsp;Priya Nair MBBS, MD, FCICM, PhD","doi":"10.1016/j.ccrj.2026.100163","DOIUrl":"10.1016/j.ccrj.2026.100163","url":null,"abstract":"<div><div>We aim to provide evidence-based clinical practice guidelines for the use of VV ECMO in adult patients across Australia and New Zealand. Developed by a multidisciplinary panel of clinicians from both countries, alongside a methodologist and patient representatives, these guidelines were produced in accordance with the National Health and Medical Research Council (NHMRC) 2016 standards for guidelines. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of evidence and inform the development of recommendations. These guidelines are intended to support, not replace, clinical judgement and should be applied in the context of individual patient circumstances, values and preferences. In this part one of a three-part series, the Guideline Development Group (GDG) addressed four core clinical questions regarding the indications for and management of VV ECMO in adults. In addition to evidence-based recommendations, this guideline incorporates expert consensus through a well-established process and highlights important gaps in current evidence to guide future research priorities.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100163"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extreme acidosis in hospitalised patients: A 10-year single-centre, retrospective analysis","authors":"Zoe Y. Guo MBBS, FCICM ,&nbsp;Humphrey GM. Walker MBBS, FCICM ,&nbsp;Alastair J. Brown MBChB, FCICM ,&nbsp;Pamisha Purewal MD ,&nbsp;David Reid GCSci AppStat ,&nbsp;John Santamaria MD, FRACP, FCICM, FCCP","doi":"10.1016/j.ccrj.2025.100160","DOIUrl":"10.1016/j.ccrj.2025.100160","url":null,"abstract":"<div><h3>Objective</h3><div>Acidaemia is a commonly occurring abnormality of acid-base balance. The literature assessing extreme acidosis (pH ≤ 7) is limited and is largely focused on those admitted to intensive care. Therefore, we sought to review the demographics, aetiologies, and outcomes of all hospitalised patients with extreme acidosis.</div></div><div><h3>Design and Setting</h3><div>This was a retrospective cohort study conducted at a single centre, tertiary hospital in Melbourne, Australia <strong><em>Participants:</em></strong> Patients with acidosis were identified using the hospital pathology database. Exclusion criteria included hospital readmissions or samples taken in a non-inpatient setting. <em><strong>Main Outcome Measures:</strong></em> The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality and the association of mortality with type and aetiology of acidosis. Data were analysed using a Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Between June 2015 and June 2025, 162,697 patients had 451,788 multi-day admissions. Five hundred eighty-six admissions were identified, in which a patient had a measured pH ≤ 7.0. The final cohort consisted of 493 first admission episodes. Three hundred twenty-four (68.5 %) were male with a median age of 59.3 (interquartile range: 41.2–71.7). By day 30, 226 (45.8 %) of patients had died. Mixed acidosis (321, 65.1 %) and cardiorespiratory arrest (160, 32.5 %) were the most frequently occurring type and aetiology of acidosis. Relative to metabolic acidosis, both mixed acidosis (adjusted hazard ratio (aHR): 2.25, 95 % CI: 1.55–3.27) and respiratory acidosis (aHR: 2.08, 95 % CI: 1.01–4.27) had a higher hazard of 30-day mortality. Causes associated with the highest risk of 30-day mortality were vascular (aHR: 31.2, 95 % CI: 9.60–101) and cardiorespiratory arrest (aHR: 27.0, 95 % CI: 9.17–79.4). One hundred nine (22.1 %) patients did not require intensive care unit admission; however, 37 (33.9 %) of these patients still had died by day 30.</div></div><div><h3>Conclusions</h3><div>Extreme acidosis is extremely rare in hospitalised inpatients. Mortality varies according to type and aetiology of the cause of acidosis and therefore careful consideration as to the implications of extreme acidosis when considering cessation of treatment is crucial.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100160"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147425114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in high-risk (HR) percutaneous coronary intervention (PCI)","authors":"Levent Uygur MD ,&nbsp;Mark Dennis FRACP PhD ,&nbsp;Michael Tierney MD ,&nbsp;Paul Forrest FANZCA ,&nbsp;Paul Bannon FRACS PhD ,&nbsp;Elliott Worku FCICM","doi":"10.1016/j.ccrj.2026.100166","DOIUrl":"10.1016/j.ccrj.2026.100166","url":null,"abstract":"<div><h3>Objective</h3><div>Mechanical circulatory support is increasingly utilised in peri-procedural contexts. Herein we describe the characteristics and outcomes of patients undergoing high-risk (HR) percutaneous coronary intervention (PCI) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support.</div></div><div><h3>Design</h3><div>Single centre, retrospective cohort study conducted at a quaternary Australian ECMO retrieval hospital.</div></div><div><h3>Methods</h3><div>Consecutive patients between January 2019 and June 2024, who received peripheral VA-ECMO support for HR-PCI were identified from the institutional ECMO database. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) to hospital discharge. Secondary endpoints included procedural success, incidence of vascular access and bleeding complications, acute kidney injury (AKI), and duration of mechanical circulatory support (MCS), ventilation, ICU and hospital length of stay.</div></div><div><h3>Results</h3><div>Seventeen patients received VA-ECMO supported HR-PCI during the study period. The median age was 70 years (IQR; 59–78). Fourteen (82 %) patients were male; fifteen (88 %) had moderate to severe left ventricular dysfunction pre-procedurally. Ten (59 %) patients underwent emergency VA-ECMO support and seven (41 %) patients were supported prophylactically, with mean pre-procedural SYNTAX scores of 39 ± 12 and 30 ± 10, respectively. Seven MACCE events occurred, all being death in the emergency group. Fifteen patients (88 %) were successfully revascularised. Significantly more patients in the emergency versus the prophylactic group developed AKI (80 % vs 14 %, p = 0.02). There were significantly more vascular and access-related complications in the emergency group (7 vs 1, p = 0.049).</div></div><div><h3>Conclusion</h3><div>In seventeen patients undergoing HR-PCI, prophylactic VA-ECMO support was feasible, safe and associated with good short-term outcomes, whilst emergency VA-ECMO supported HR-PCI was associated with greater burden of mortality and morbidity. Larger prospective studies, including cost analysis comparing other MCS devices are required.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100166"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, treatment, and outcomes of sepsis during rapid response team calls: A systematic review and meta-analysis","authors":"Lionel Soh BSC(Hons), MBBS ,&nbsp;Ryan Ruiyang Ling MBBS ,&nbsp;Wei Ling Chua PhD ,&nbsp;Joshua Junjie Aw FCFP(S) ,&nbsp;Natalie Robertson MPH ,&nbsp;Kundan Reddy Saripalli MMed IM ,&nbsp;Deb Sharp MAdvNursPrac(NPrac-CriticalCare) ,&nbsp;Sophia Zhao MD ,&nbsp;Daryl Jones BSc(Hons), MBBS, FRACP, FCICM, MD, PhD ,&nbsp;Ashwin Subramaniam MBBS, GChPOM, MMed, FRACP, FCICM, PhD","doi":"10.1016/j.ccrj.2026.100172","DOIUrl":"10.1016/j.ccrj.2026.100172","url":null,"abstract":"<div><h3>Introduction</h3><div>Sepsis is a leading cause of morbidity and mortality in hospitalised patients. Rapid Response Teams (RRTs) review clinically deteriorating patients, including those with sepsis. However, the epidemiology of sepsis in RRT calls remains unclear. This systematic review synthesised evidence on the prevalence, treatment, and outcomes of sepsis during RRT calls.</div></div><div><h3>Methods</h3><div>Seven electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Ovid MEDLINE, and Scopus) were searched for studies published from 1 January 2015 to 31 May 2024. All articles were independently screened and assessed for study quality using the Newcastle Ottawa Scale by two reviewers per article. The primary outcome was the prevalence of sepsis during RRT calls. Secondary outcomes included hospital mortality and length of hospitalisation. Data were pooled using random-effects meta-analyses.</div></div><div><h3>Results</h3><div>From 5632 studies screened, 26 studies encompassing 110,909 patients and 139,076 RRT events were included. The pooled mean age was 64.4 years (95%CI: 59.2–69.7) and 48.4 % (n = 51,720, 24 studies) were male. The pooled prevalence of sepsis among all RRT calls was 23.7 % (95%CI: 15.5 %–34.6 %), with no significant difference between studies including exclusively sepsis RRT calls and studies with all causes of RRT calls (32.7 % vs. 21.8 %; p = 0.16). Common sepsis-related RRT triggers included abnormal respiratory and heart rates. Overall hospital mortality was 12.9 % (95%CI: 7.3–21.7 %) and hospital length of stay was 18 days (95%CI: 13.9–22.1), both showing no significant differences between studies including exclusively sepsis RRT calls and studies with all causes of RRT calls. New or changes in antibiotics were initiated in 38.8 % of sepsis-related RRTs. Most patients remained on the ward, while 23.3 % were transferred to the ICU.</div></div><div><h3>Conclusions</h3><div>Sepsis is a trigger for a quarter of RRT calls, associated with substantial resource use and mortality in one eighth of patients. These findings support the need for standardised recognition protocols, escalation guidelines and prospective trials to optimise outcomes.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100172"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for a multicentre target trial emulation comparing ketamine and propofol in critically ill adults undergoing emergency intubation","authors":"Rafael von Hellmann MD ,&nbsp;Ryan Ruiyang Ling MBBS ,&nbsp;Michael Toolis MBBS MRCPI FCICM ,&nbsp;Tapan Parikh Aka Parmar MBBS, MD DNB Anae, FIPM, FCICM, AFRACMA, GDipClinUS ,&nbsp;Ashwin Subramaniam MBBS, GChPOM, MMed, FRACP, FCICM, PhD","doi":"10.1016/j.ccrj.2026.100171","DOIUrl":"10.1016/j.ccrj.2026.100171","url":null,"abstract":"<div><h3>Background</h3><div>Emergency intubation in the critically ill adults is frequently complicated by haemodynamic instability and severe hypoxaemia. Ketamine and propofol are widely used for induction, yet high-quality comparative effectiveness evidence in real-world emergency department, medical ward, and intensive care unit (ICU) settings remains limited.</div></div><div><h3>Objective</h3><div>To estimate the causal effect of ketamine versus propofol as the principal induction agent for emergency intubation in critically ill adults and using a target trial emulation framework with competing risks survival analysis.</div></div><div><h3>Design, setting and participants</h3><div>A retrospective multicentre cohort across the Monash Health network, emulating a hypothetical randomised trial. Adults (≥18 years) undergoing unplanned endotracheal intubation in the emergency department, medical ward, or ICU with subsequent ICU admission will be included.</div></div><div><h3>Intervention</h3><div>Induction with ketamine or propofol as the principal sedative-hypnotic agent.</div></div><div><h3>Main outcome measures</h3><div>Primary outcome will be in-hospital mortality, assessed from induction until death, hospital discharge, or 28 days, whichever occurs first. The secondary outcomes will be a composite peri-intubation adverse event, defined as haemodynamic collapse or severe hypoxaemia within 30 min of intubation.</div></div><div><h3>Conclusion</h3><div>This target trial emulation will provide real-world causal evidence comparing ketamine versus propofol induction for high-risk emergency intubation, with the potential to inform practice, protocols, and future randomised trials.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100171"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic acidosis and sodium bicarbonate therapy in critically ill patients: A multinational survey of international and Chinese practitioners","authors":"Alessandro Caroli MD ,&nbsp;Lingliang Zhou MD ,&nbsp;Anis Chaba MD ,&nbsp;Glenn Eastwood PhD ,&nbsp;Yukiko Hikasa MD ,&nbsp;Nuanprae Kitisin MD ,&nbsp;Tianlong Li MD ,&nbsp;Weiqin Li PhD ,&nbsp;Xiaohua Lin PhD ,&nbsp;Yang Liu MD ,&nbsp;Cheng Lv PhD ,&nbsp;Akinori Maeda MD ,&nbsp;Mairead McNamara BAppSC, MDietPrac ,&nbsp;Jonathan Nübel MD ,&nbsp;Chun Pan PhD ,&nbsp;Nattaya Raykateeraroj MD ,&nbsp;Sofia Spano MD ,&nbsp;Xiaoyi Xu PhD ,&nbsp;Haigang Zhang PhD ,&nbsp;Lu Ke PhD ,&nbsp;Ary Serpa Neto PhD","doi":"10.1016/j.ccrj.2026.100167","DOIUrl":"10.1016/j.ccrj.2026.100167","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate critical care professionals’ perceptions of the burden of metabolic acidosis (MA) in the intensive care unit (ICU), and assess agreement on indications, modalities, risks, and benefits of sodium bicarbonate therapy.</div></div><div><h3>Design</h3><div>A multinational, web-based survey administered at different times to Chinese and international ICU practitioners.</div></div><div><h3>Main outcome measures</h3><div>The survey comprised 20 items across four domains: 1) perceived epidemiology and research relevance of MA; 2) rationale, indications, and treatment modalities; 3) potential benefits of sodium bicarbonate; and 4) potential adverse effects of sodium bicarbonate. Responses were recorded on a 5-point Likert scale and classified as <em>“Agreed”</em>, <em>“Disagreed”</em>, or <em>“Uncertain”</em>.</div></div><div><h3>Results</h3><div>A total of 1279 responses from 20 countries were analysed. MA was widely recognised as common, clinically relevant, a frequent cause of ICU admission, and an area requiring further research. Most clinicians supported targeted therapy beyond treating underlying causes, though uncertainty remained regarding sodium bicarbonate. Chinese respondents favoured early correction and continuous infusion, while international opinions varied on timing and approach. Perceived benefits, such as reduced vasopressor use and respiratory workload, were supported by Chinese clinicians, whereas international ones remained uncertain. Opinions on adverse effects also diverged. Chinese physicians highlighted risks of hypernatraemia, severe alkalosis, and hypokalemia, while international respondents viewed sodium bicarbonate as safe regarding the risk of fluid overload or pulmonary oedema.</div></div><div><h3>Conclusions</h3><div>This international survey shows broad agreement that MA is a clinically important and understudied condition in the ICU but reveals substantial variability and uncertainty in clinicians’ perceptions of sodium bicarbonate therapy, with notable differences between Chinese and international respondents. These findings underscore key knowledge gaps and the need for well-designed clinical trials.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100167"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Critical Care Outcome Prediction Equation (COPE) model, version 7” [Crit Care Resusc 27 (4) (2025) 100131]","authors":"G.J. Duke ,&nbsp;S. Hirth ,&nbsp;J.D. Santamaria ,&nbsp;F. Shann ,&nbsp;D. Pilcher ,&nbsp;F. Oberender ,&nbsp;C. Knott ,&nbsp;J. Moran","doi":"10.1016/j.ccrj.2025.100158","DOIUrl":"10.1016/j.ccrj.2025.100158","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100158"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current practice, training and skill assessment of central venous access device insertion: Perspectives of intensive care trainees in adult intensive care units across Australia and New Zealand and their recommendations for improvement","authors":"Tapan Parikh MBBS, MD DNB Anae, FIPM, FCICM, AFRACMA, GDipClinUS ,&nbsp;Wisam Al Bassam MBChB, FCICM, GCCritCareEcho ,&nbsp;Yahya Shehabi PhD, FANZCA, FCICM, GAICD, EMBA ,&nbsp;Deepak Bhonagiri MBBS, MD, FCICM ,&nbsp;Tim Leong MBBS, FCICM, DDU Crit care, PGDipHSM ,&nbsp;Adrian Pakavakis MBBS, MSc Oxon, FRACP, FCICM, GDipClinUS ,&nbsp;Brendan Murfin MBBCH, MMEDClinEpi, GDipClinUS, FCICM ,&nbsp;Ashwin Subramaniam MBBS, MMeD Internal Medicine, GChPOM, FRACP, FCICM, PhD","doi":"10.1016/j.ccrj.2025.100159","DOIUrl":"10.1016/j.ccrj.2025.100159","url":null,"abstract":"<div><h3>Objective</h3><div>Central venous access device (CVAD) insertion is a routine procedure in intensive care units (ICUs); however, it is associated with procedural risks. While structured training enhances safety, significant variability exists in training, supervision, and competency assessment across ICUs. Standardised education and assessment frameworks are recommended to improve procedural safety and patient outcomes. This study aimed to evaluate ICU trainees’ experiences with CVAD insertion training, identify any significant variation in current educational frameworks, and gather recommendations for enhancing training and assessment.</div></div><div><h3>Design</h3><div>A web-based survey was distributed to ICU trainees across Australia, New Zealand, Singapore, and Hong Kong. Data were analysed using descriptive statistics and regression models.</div></div><div><h3>Main outcome measures</h3><div>Key outcomes included trainee's perceptions of training disparities, accreditation processes, and practice variations across ICUs, informing the development of a standardised CVAD training framework.</div></div><div><h3>Results</h3><div>Among 237 respondents, 199 responses were analysed. Fewer than two-thirds of trainees in tertiary and metropolitan ICUs and only 17% in regional and private ICUs, reported access to structured multimodal CVAD training, while 15.3% indicated no formal training was available. Fewer than a quarter (23.1%) of less experienced trainees reported having undergone competency assessments in the past 12 months. Commonly perceived challenges included coordinating ultrasound guidance and manipulating the guidewire and catheter. Most trainees (52.3%) recommended six to ten supervised insertions and competency across multiple insertion sites (∼60%) for accreditation.</div></div><div><h3>Conclusions</h3><div>These findings highlight trainees' perceptions of critical gaps in CVAD training, emphasising the need for structured multimodal education, standardised competency assessments, and improved access to training resources across diverse ICU settings.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100159"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and pharmacological management of new onset atrial fibrillation in critically ill adults: A multicentre observational study","authors":"Kerina J. Denny BSc MBBS PhD FCICM ,&nbsp;Stephen Whebell MBBS FCICM ,&nbsp;James P.A. McCullough MBChB FCICM MMed ,&nbsp;Kevin B. Laupland MD MSc PhD FCICM ,&nbsp;Sebastiaan Blank FCICM ,&nbsp;Alexis Tabah MD FCICM ,&nbsp;Kiran Shekar MBBS PhD FCICM ,&nbsp;Peter Garrett BSc MBBS FCICM ,&nbsp;Mahesh Ramanan BSc MBBS MMed FCICM ,&nbsp;Antony G. Attokaran MBBS FCICM ,&nbsp;Eamon Raith MBBS PhD FCICM ,&nbsp;Humphrey G.M. Walker MBBS MRCP FCICM ,&nbsp;Alastair Brown BSc MBChB FCICM ,&nbsp;Kyle C. White BSc MBBS MPH FCICM FRACP","doi":"10.1016/j.ccrj.2026.100162","DOIUrl":"10.1016/j.ccrj.2026.100162","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to determine the incidence of new onset atrial fibrillation (NOAF) in a cohort of intensive care unit (ICU) patients and, further, identify commonly utilised pharmacological strategies for its management in patients with and without sepsis.</div></div><div><h3>Design</h3><div>A multicentre, retrospective observational study was conducted.</div></div><div><h3>Setting</h3><div>Twelve ICUs in Queensland, Australia.</div></div><div><h3>Participants</h3><div>Adult patients, excluding those with cardiothoracic surgical diagnoses, admitted to a participating ICU from 2015 to 2021.</div></div><div><h3>Main outcome measures</h3><div>Main outcome measures included the incidence of NOAF in ICU, association of NOAF with illness severity and outcomes, cardiac rhythm at ICU discharge, and incidence of pharmacological intervention for NOAF in the ICU.</div></div><div><h3>Results</h3><div>NOAF occurred in 8.4 % of included ICU admissions, and was associated with higher illness severity, length of stay, and mortality. The majority of patients who experienced NOAF and survived their ICU stay were discharged from the ICU in a sinus rhythm (68.6 %). Patients with sepsis-associated NOAF were more likely to be in a sinus rhythm at ICU discharge than patients with NOAF without sepsis (72.2 vs 65.7 %). Amiodarone was frequently (50.4 %) prescribed to patients both with (56.5 %) and without (45.3 %) sepsis.</div></div><div><h3>Conclusion</h3><div>NOAF was common amongst patients admitted to the ICU, and amiodarone is commonly prescribed. Future studies are required to determine the optimal short- and long-term management strategies for NOAF complicating critical illness.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100162"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sample size requirements and intra-cluster correlations for stepped wedge cluster randomised trials in intensive care medicine: A practical guide","authors":"Thomas Hughes-Gooding MBChB ,&nbsp;Diva Baggio MBBS, MBioStat ,&nbsp;Edward Litton MBBS, PhD ,&nbsp;David Pilcher MBBS ,&nbsp;Paul J. Young MBChB, PhD ,&nbsp;Jessica Kasza PhD","doi":"10.1016/j.ccrj.2026.100168","DOIUrl":"10.1016/j.ccrj.2026.100168","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate key statistical parameters and provide practical guidance for planning stepped wedge cluster randomised trials in Australian and New Zealand intensive care units (ICUs).</div></div><div><h3>Design</h3><div>Cross-sectional retrospective observational study using routinely collected ICU data.</div></div><div><h3>Setting</h3><div>Adult public hospital ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database between 2010 and 2023.</div></div><div><h3>Participants</h3><div>All adult ICU admissions to 132 ICUs. Subgroups included unplanned admissions and admissions involving invasive mechanical ventilation or vasopressor use.</div></div><div><h3>Main outcome measures</h3><div>In-hospital mortality during the index hospitalisation within 90 days of ICU admission. Intra-cluster correlation coefficients (ICCs) and cluster auto-correlations (CACs) were estimated using exchangeable, block-exchangeable, and discrete time decay models using a cross-sectional design.</div></div><div><h3>Results</h3><div>Among 1,291,849 eligible ICU admissions, observed mortality ranged from 10.3% (all ICU admissions) to 23.0% (non-elective invasively ventilated patients in Mega-ROX ICUs). ICCs ranged from 0.008 to 0.022 and CACs from 0.83 to 1.00, with block-exchangeable or discrete time decay models most often providing the best fit. In a worked example, a 50-ICU stepped wedge trial with 10 steps (11 two-month periods) enrolling 45 unplanned ventilated patients per ICU per period (total ≈24,750 patients) would have 81.6% power to detect an absolute mortality reduction of 2.7%.</div></div><div><h3>Conclusions</h3><div>Stepped wedge cluster randomised trials are feasible for evaluating ICU-wide interventions when routine data are available. The ICC and CAC estimates presented here provide Australian and New Zealand-specific parameters for future trial planning and demonstrate the potential of this design for pragmatic large-scale ICU research.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"28 1","pages":"Article 100168"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}