Critical Care and Resuscitation最新文献

{"title":"In memory of professor Rinaldo Bellomo: A giant of intensive care medicine","authors":"Ary Serpa Neto MD, MSc, PhD, FCICM , Paul Young PhD, FCICM","doi":"10.1016/j.ccrj.2025.100110","DOIUrl":"10.1016/j.ccrj.2025.100110","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100110"},"PeriodicalIF":1.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124628","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 summary and statistical analysis plan for the sodium bicarbonate for metabolic acidosis in the intensive care unit (SODa-BIC) trial","authors":"Ary Serpa Neto MD, MSc, PhD ,&nbsp;Mairead McNamara BAppSc, MDietPrac ,&nbsp;Jamie Cooper MD ,&nbsp;Tomoko Fujii MD, PhD ,&nbsp;Alisa Higgins PhD ,&nbsp;Carol Hodgson PhD ,&nbsp;Leanlove Navarra BSN ,&nbsp;Alistair Nichol MD, PhD ,&nbsp;Sandra Peake MD, PhD ,&nbsp;Alvaro Rea-Neto MD, MSc, PhD ,&nbsp;Paul Secombe BMBS(hons) MClinSc, FCICM ,&nbsp;Emily See MD ,&nbsp;Pam Taylor ,&nbsp;Meredith Young MPH ,&nbsp;Fernando G. Zampieri MD, PhD ,&nbsp;Paul Young PhD, FCICM ,&nbsp;Rinaldo Bellomo MD, PhD ,&nbsp;Andrew Udy MBChB, PhD ,&nbsp;SODa-BIC investigators","doi":"10.1016/j.ccrj.2025.100108","DOIUrl":"10.1016/j.ccrj.2025.100108","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic acidosis is common in critically ill patients and is associated with increased risk of organ dysfunction, need for renal replacement therapy, and death. Despite its frequency and clinical relevance, the optimal treatment approach remains uncertain. Sodium bicarbonate is often used to correct acidosis, but its risk–benefit profile in this setting is unclear.</div></div><div><h3>Objective</h3><div>To describe the study protocol and statistical analysis plan for the sodium bicarbonate for metabolic acidosis in the intensive care unit (SODa-BIC) trial.</div></div><div><h3>Design, setting and participants</h3><div>Protocol for an international, multicentre, randomised, double-blind, parallel-group, superiority adaptive clinical trial. Five hundred (n = 500) adults with metabolic acidosis and receiving a continuous infusion of a vasopressor will be randomly assigned to sodium bicarbonate or placebo in a 1:1 ratio. SODa-BIC started recruiting in April 2023. It is anticipated that recruitment will be completed in 2026.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome will be major adverse kidney events within 30 days (MAKE30). Secondary and tertiary outcomes include 30- and 90-day mortality, receipt of renal replacement therapy, and vasopressor-free and ICU-free days at day 30. All analyses will be conducted on an intention-to-treat basis.</div></div><div><h3>Results and conclusions</h3><div>SODa-BIC will evaluate whether sodium bicarbonate improves clinically meaningful outcomes in critically ill patients with metabolic acidosis. The trial has the potential to inform international practice guidelines and provide robust evidence to guide the treatment of a common and severe condition in the intensive care unit.</div></div><div><h3>Registration</h3><div>Clinicaltrials.gov (NCT05697770).</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100108"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068339","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":"Study protocol and statistical plan for the ICRAKI trial: Intermittent haemodialysis versus continuous renal replacement therapy for severe acute kidney injury in critically ill patients","authors":"Stéphane Gaudry MD, PhD ,&nbsp;Marouane Boubaya MD ,&nbsp;Guillaume Louis MD ,&nbsp;Khalil Chaïbi MD, PhD ,&nbsp;Bruno Mégarbane MD, PhD ,&nbsp;Julien Bohe MD, PhD ,&nbsp;Maxime Desgrouas MD ,&nbsp;Guillaume Gele-Decaudin MD ,&nbsp;Adrien Joseph MD, PhD ,&nbsp;Etienne de Montmollin MD, PhD ,&nbsp;Christophe Camus MD, PhD ,&nbsp;Nicolas De Prost MD, PhD ,&nbsp;Pierre Bailly MD ,&nbsp;Samir Jaber MD, PhD ,&nbsp;Nicolas Chudeau MD ,&nbsp;Alexis Lambour MD ,&nbsp;Adrien Robine MD ,&nbsp;Béatrice La Combe MD, PhD ,&nbsp;Antoine Kimmoun MD, PhD ,&nbsp;Guillaume Chevrel MD ,&nbsp;Didier Dreyfuss MD","doi":"10.1016/j.ccrj.2025.100107","DOIUrl":"10.1016/j.ccrj.2025.100107","url":null,"abstract":"<div><h3>Background</h3><div>The effect of intermittent haemodialysis (IHD) <em>vs</em> continuous renal replacement therapy (CRRT) on mortality and/or renal function recovery in adults with acute kidney injury (AKI) and a recognised indication for renal replacement therapy (RRT) remains controversial.</div></div><div><h3>Objective</h3><div>To summarise the protocol and statistical analysis plan for the ICRAKI trial.</div></div><div><h3>Design, settings and participants</h3><div>ICRAKI is a non-inferiority multicentre randomised controlled trial comparing IHD and CRRT. We will include 1000 patients with AKI receiving (or who have received) invasive mechanical ventilation and/or catecholamine infusion and who have at least one recognised criterion for initiating RRT.</div></div><div><h3>Intervention</h3><div>The study compares IHD with CRRT.</div></div><div><h3>Main outcomes measures</h3><div>The primary endpoint is the proportion of patients who will meet one or more criteria for a major adverse kidney event (composite of death, RRT dependence and/or more than a 25 % increase in serum creatinine from baseline value) 90 days after randomisation. Secondary endpoints are time to death; mortality at day (D)28, D60 and D90; number of patients with RRT dependency at D28, D60 and D90; number of patients with more than a 25 % increase in serum creatinine from baseline value at D28, D60 and D90; intensive care unit (ICU) and hospital length of stay; time until cessation of RRT; catecholamine-free days, ventilator-free days and RRT-free days through day 28; estimated glomerular filtration rate at hospital discharge; the number of episodes of adverse events.</div></div><div><h3>Conclusion</h3><div>The ICRAKI trial will inform the choice of RRT modalities in critically ill patients with severe AKI. More than 300 patients were already included.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov: <span><span>NCT06032884</span><svg><path></path></svg></span>. Date of registration, 2023-09-04.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100107"},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906124","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":"A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial","authors":"Mahesh Ramanan FCICM PhD ,&nbsp;Yogesh Apte FCICM MDS ,&nbsp;Stacey Watts RN GradCert (Crit Care) ,&nbsp;Thomas Holland FACEM MBBS ,&nbsp;April Hatt RNA ,&nbsp;Alison Craswell RN PhD ,&nbsp;Frances Lin RN PhD ,&nbsp;Alexis Tabah FCICM MDR ,&nbsp;Robert S. Ware PhD ,&nbsp;Joshua Byrnes PhD ,&nbsp;Christopher Anstey FCICM PhD ,&nbsp;Gerben Keijzers FACEM PhD","doi":"10.1016/j.ccrj.2025.100106","DOIUrl":"10.1016/j.ccrj.2025.100106","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the feasibility of conducting a definitive randomised trial to determine whether, in critically ill patients requiring intensive care unit admission, early CVC insertion compared with late CVC insertion leads to increased days-alive-and-out-of-hospital at 30 days (DAH-30) post-treatment.</div></div><div><h3>Design, settings and participants</h3><div>We conducted a single-centre, parallel-group, feasibility randomised controlled trial with critically ill patients receiving vasopressor infusions randomised in a 1:1 ratio to receive early CVC insertion (within 4 h) or late CVC insertion (after 12 h). All patients received vasopressor infusions via a peripheral intravenous cannula (PIVC) while awaiting CVC insertion. The primary clinical outcome was DAH-30 and the primary feasibility outcome was assessed by evaluating protocol adherence, rates of recruitment, randomisation of eligible patients, retention, follow-up and missing data.</div></div><div><h3>Results</h3><div>We enrolled 40 patients, 20 patients per group between January 2023 and May 2024. Protocol adherence was significantly lower in the early CVC group (55 %) compared to the late CVC group (100 %, p &lt; 0.001). The early CVC group had a median time to CVC insertion of 3.3 h (interquartile range (IQR) 1.2–3.7 h), within the 4-h target. The early and late CVC groups had a median (IQR) of 13.5 (0.0–23.5) and 19.0 (5.0–23.0) DAH-30 respectively (P = 0.18). PIVC complications were similar between the two groups with no severe complications. There were no complications among the 18 CVCs inserted during the trial.</div></div><div><h3>Conclusions</h3><div>Protocol adherence in the early CVC was much lower than the late CVC. Some protocol modifications will be required to enable the conduct of a larger-scale definitive trial.</div></div><div><h3>Trial Registration</h3><div>ACTRN12621000721808 (Australia New Zealand Clinical Trials Registry).</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100106"},"PeriodicalIF":1.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838937","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":"Trends in pulmonary artery catheter use for cardiac surgery, 2013–2023: Analysis of Australian medicare data","authors":"Luke A. Perry MBBS(Hons), BSc,&nbsp;Andrew Silvers FANZCA,&nbsp;Jayme Bennetts FRACS,&nbsp;Julian Smith FRACS,&nbsp;Lisa Q. Rong MD, MSCE, FASE, FACC,&nbsp;Mario Gaudino MD, PhD, MSCE, FEBCTS, FACC, FAHA,&nbsp;Lachlan F. Miles MBBS (Hons), PGCertCU, PhD, GChPOM, FANZCA","doi":"10.1016/j.ccrj.2025.100100","DOIUrl":"10.1016/j.ccrj.2025.100100","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100100"},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ donation from extracorporeal membrane oxygenation and ventricular assist devices in Victoria, Australia: Characteristics and trends","authors":"Viveka K. Nainani MBBS BMedSci ,&nbsp;Byron Arcia Data analyst ,&nbsp;David Pilcher MBBS MRCP (UK) FCICM FRACP ,&nbsp;Joshua Ihle FCICM ,&nbsp;Arne Diehl FCICM ,&nbsp;Samuel Radford FCICM FRACP ,&nbsp;Rohit D'Costa FRACP FCICM MBioEth ,&nbsp;Vinodh B. Nanjayya FCICM","doi":"10.1016/j.ccrj.2025.100102","DOIUrl":"10.1016/j.ccrj.2025.100102","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the characteristics and the trend of organ donation from donors on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (LVAD).</div></div><div><h3>Design</h3><div>Retrospective, observational, cohort study from June 2014 to June 2021.</div></div><div><h3>Setting</h3><div>A multicentre study in Victoria, Australia, using DonateLife Victoria databases.</div></div><div><h3>Participants</h3><div>All patients on ECMO/LVAD were referred to DonateLife for organ donation.</div></div><div><h3>Main outcome measures</h3><div>Number, proportion, time trend and type of organ donations from the patients on ECMO/LVAD.</div></div><div><h3>Results</h3><div>There were 78 donor referrals [mean (SD) age 42 (18.8) yrs, 56 (72 %) males] from patients on Veno-arterial ECMO (73 %), Veno-venous ECMO (16 %) or LVAD (6.4 %), of which 37 (47 %) donated. The annual median (IQR) referral and donation rates were 8 (5–10)/year and 4 (3–7)/year, respectively. Medical contraindications were the main reason for declining organ donation [21(51 %)]. Donation after neurological determination of death (DNDD) occurred in 20 (54 %), and donation after circulatory determination of death (DCDD) in 17 (46 %). The median (IQR) time from admission to referral for donation was longer in DCDD compared to DNDD patients. Eighty-three organs were retrieved from 37 donors (2.24 organs per donor), out of which 68 organs (82 %) were transplanted in 68 recipients. Kidneys were the most common organs retrieved (73 %) and transplanted (79 %).</div></div><div><h3>Conclusion</h3><div>Organ donation on ECMO/LVAD occurs only in half of the referred patients. Further studies are needed to ascertain the barriers to donations and to assess the long-term outcomes of these donations.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100102"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care admissions for adults with treated kidney failure in Australia: A national retrospective cohort study","authors":"Dominic Keuskamp PhD ,&nbsp;Christopher E. Davies PhD ,&nbsp;Paul J. Secombe BMBS (Hons) MClinSc FCICM ,&nbsp;David V. Pilcher MBBS MRCP(UK) FRACP FCICM ,&nbsp;Shaila Chavan MSPH ,&nbsp;Sarah L. Jones MBChB (Hons) MRCP(UK) DICM(UK) FCICM FRACP ,&nbsp;Benjamin E. Reddi MA PhD FRCP(UK) FCICM ,&nbsp;Stephen P. McDonald MBBS (Hons) PhD FRACP","doi":"10.1016/j.ccrj.2025.100099","DOIUrl":"10.1016/j.ccrj.2025.100099","url":null,"abstract":"<div><h3>Objective</h3><div>Limited data are available on intensive care unit (ICU) admissions for adults receiving kidney replacement therapy (KRT – dialysis or transplantation) in Australia. Our aim is to characterise admissions for patients receiving long-term dialysis and kidney transplant recipients relative to the general intensive care population in Australia.</div></div><div><h3>Design</h3><div>Retrospective registry-based data linkage cohort study.</div></div><div><h3>Setting</h3><div>All ICUs in Australia that reported to the Australian and New Zealand Intensive Care Society Adult Patient Database, 1 January 2018–31 December 2020.</div></div><div><h3>Participants</h3><div>All admissions were included. Data were deterministically linked to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Subgroups analysed were defined by sex, age, admission type, APACHE III-j diagnostic category, diabetes status, body mass index (BMI), dialysis modality, dialysis vintage, and kidney transplant vintage.</div></div><div><h3>Outcome measures</h3><div>Admission to ICU for patients receiving KRT at the time of admission (as reported to the ANZDATA Registry).</div></div><div><h3>Results</h3><div>Patients receiving long-term dialysis prior to admission and those with a kidney transplant numbered 2826 (0.6% of all admissions) and 1194 (0.3%), respectively. Age-sex standardised admission rates relative to the non-KRT cohort (n = 438,271 or 99.1%) were highest for long-term dialysis patients (relative rate 10.18 [95% CI: 9.46,10.93]) and associated with diabetes and sepsis, cardiovascular and respiratory diagnoses.</div></div><div><h3>Conclusions</h3><div>Rates of ICU admission for people receiving long-term dialysis or kidney transplantation were many times higher than the general population, with particularly increased relative risk among younger age groups and for key medical diagnoses. Given the burden on patients and health services, exploration of strategies to reduce this risk is important.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100099"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey","authors":"Paul J. Young MBChB, PhD ,&nbsp;Rinaldo Bellomo MBBS, MD, FCICM, FRACP ,&nbsp;Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP ,&nbsp;David GC. Antognini MBBS ,&nbsp;Yaseen M. Arabi MD ,&nbsp;Muhammad Sheharyar Ashraf MD ,&nbsp;Sean M. Bagshaw MD, MSc ,&nbsp;Alastair J. Brown MBChB ,&nbsp;Sarah Buabbas MD ,&nbsp;Lewis Campbell MBChB, MSc ,&nbsp;Jonathan M. Chen MBChB ,&nbsp;Ross C. Freebairn MBChB ,&nbsp;Tomoko Fujii MD, PhD ,&nbsp;Mohd Shahnaz Hasan MBBS, MAnes ,&nbsp;Aditi Jain DNB, FRCPC, FCCCM, AFIC ,&nbsp;Nai An Lai MBBS, MRCSEd, FRCP(Edin), FCICM ,&nbsp;Sanjay Lakhey MD ,&nbsp;Matthew Mac Partlin MBChB, FCICM, FACEM, MRCPI ,&nbsp;Sam Marment MBChB ,&nbsp;James P.A. McCullough MBChB, MMed ,&nbsp;François Lamontagne MD, MSc","doi":"10.1016/j.ccrj.2024.12.001","DOIUrl":"10.1016/j.ccrj.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate intensive care doctors’ views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.</div></div><div><h3>Design</h3><div>An online survey was conducted.</div></div><div><h3>Setting and participants</h3><div>An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.</div></div><div><h3>Main outcome measures</h3><div>Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.</div></div><div><h3>Results</h3><div>The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.</div></div><div><h3>Conclusions</h3><div>Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100095"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital mortality in patients admitted to Australian intensive care units with COVID-19 between 2020 and 2024","authors":"Matthew T. Donnan MBBS ,&nbsp;Peinan Zhao PhD ,&nbsp;Allen C. Cheng MBBS PhD ,&nbsp;Aaliya Ibrahim MClinEpid ,&nbsp;Annamaria Palermo RN, BA ,&nbsp;Benjamin Reddi FCICM PhD ,&nbsp;Claire Reynolds MNurs ,&nbsp;Craig French MBBS ,&nbsp;Edward Litton MBChB PhD ,&nbsp;Hannah Rotherham MBBS ,&nbsp;Husna Begum PhD ,&nbsp;Jamie Cooper MD MBBS ,&nbsp;Jodi Dumbrell MPH ,&nbsp;Lewis Campbell FCICM MSc. ,&nbsp;Mark Plummer PhD ,&nbsp;Mahesh Ramanan FCICM MMed ,&nbsp;Patricia Alliegro MD ,&nbsp;Richard E. McAllister RN, BN ,&nbsp;Simon Erickson MBBS, CICM ,&nbsp;Shweta Priyadarshini FCICM MBBS ,&nbsp;Aidan Burrell MBBS PhD","doi":"10.1016/j.ccrj.2024.11.003","DOIUrl":"10.1016/j.ccrj.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe and compare the demographics, management, and outcomes for patients with COVID-19 admitted to intensive care units (ICUs) in Australia across the various waves of the COVID pandemic.</div></div><div><h3>Design, setting, and participants</h3><div>People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.</div></div><div><h3>Main outcome measures</h3><div>Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.</div></div><div><h3>Results</h3><div>From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The <em>Wild Type w</em>ave included 518 (5.1%) patients, the <em>Delta</em> wave 2467 (24.3%) patients, and the <em>Omicron</em> wave 7186 (70.7%) patients. The median (IQR) age was 61 (49–70) years, 54 (41–66) years, and 65 (45–75) years, respectively (P &lt; 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the <em>Omicron</em> subvariant waves (range 60.0%–71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P &lt; 0.001). Use of extracorporeal membrane oxygenation was highest during the <em>Delta</em> wave (3.6%, 83 patients, median duration 18 days [IQR 9.8–35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the D<em>elta</em> (adjusted HR 1.80, 95% CI: 1.38–2.35, <em>p</em> &lt; 0.001) and <em>Omicron</em> (adjusted HR 1.88, 95% CI: 1.46–2.42, <em>p</em> &lt; 0.001) waves when compared to the <em>Wild Type</em> wave.</div></div><div><h3>Conclusion</h3><div>COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the <em>Omicron</em> wave demonstrated the highest in-hospital mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100094"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework and analytical exploration for a data-driven update of the Sequential Organ Failure Assessment (SOFA) score in sepsis","authors":"Drago Plečko PhD ,&nbsp;Nicolas Bennett PhD ,&nbsp;Ida-Fong Ukor MBBS ,&nbsp;Niklas Rodemund MD ,&nbsp;Ary Serpa-Neto MD, PhD ,&nbsp;Peter Bühlmann PhD","doi":"10.1016/j.ccrj.2025.100105","DOIUrl":"10.1016/j.ccrj.2025.100105","url":null,"abstract":"<div><h3>Objective</h3><div>The Sepsis-3 consensus statement emphasised the need for data-based approaches to organ failure assessment and use the Sequential Organ Failure Assessment (SOFA) for this purpose. We aimed to develop a framework for a data-driven update to the SOFA score for patients with sepsis.</div></div><div><h3>Design</h3><div>Systematic analysis of potential markers of organ dysfunction in a retrospective, observational study.</div></div><div><h3>Setting</h3><div>Intensive care units from three tertiary hospital centres in the United States, the Netherlands, and Austria were included in the study.</div></div><div><h3>Participants</h3><div>28 100 American, 5339 Dutch, and 2450 Austrian patients with suspected sepsis were included in this study.</div></div><div><h3>Measurements and main results</h3><div>We assessed 56 organ function variables. We applied area under curve maximisation procedures to optimise the predictive power for mortality. We chose the most predictive biomarker for existing organ dysfunction domains and added a metabolic domain. We compared the area under the receiver operating characteristic curve and the area under the precision recall curve of the data-driven approach against the current SOFA system. The novel approach outperformed the current SOFA in all domains and databases (the area under the receiver operating characteristic curve: for US patients: 0.766 vs. 0.727, mortality: 10.7%; for Dutch patients: 0.70 vs. 0.653, mortality: 22.0%; for Austrian patients: 0.704 vs. 0.665, mortality: 22.0%; all p &lt; 0.01 for the best performing score). The precision-recall curve confirmed such observations.</div></div><div><h3>Conclusions</h3><div>We developed and validated a framework for a data-driven update to the SOFA to identify and classify organ dysfunction in suspected septic patients. This framework can be used to revise the SOFA score and its application to the identification and classification of sepsis.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100105"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}