Critical Care and Resuscitation最新文献

{"title":"Trends in pulmonary artery catheter use for cardiac surgery, 2013–2023: Analysis of Australian medicare data","authors":"Luke A. Perry MBBS(Hons), BSc, Andrew Silvers FANZCA, Jayme Bennetts FRACS, Julian Smith FRACS, Lisa Q. Rong MD, MSCE, FASE, FACC, Mario Gaudino MD, PhD, MSCE, FEBCTS, FACC, FAHA, 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}

{"title":"Sleep in the ICU – A complex challenge requiring multifactorial solutions","authors":"Oystein Tronstad BPhty ,&nbsp;John F. Fraser MBChB, PhD, FRCP Glas, FRCA, FFARCSI, FCICM","doi":"10.1016/j.ccrj.2025.100097","DOIUrl":"10.1016/j.ccrj.2025.100097","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100097"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511065","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":"Protocol for the development of NHMRC-endorsed guidelines for extracorporeal membrane oxygenation using GRADE methodology","authors":"Sally F. Newman BN, PGCert ,&nbsp;Zachary Munn PhD, GradDip HlthSc, BMedRad ,&nbsp;Craig French FCICM ,&nbsp;Hergen Buscher DEAA, EDIC, FCICM ,&nbsp;Daniel Thomas Chung BMed MD ,&nbsp;Myles Smith MBBS, MBiostat, EDIC, FCICM ,&nbsp;Madeline Wilkinson MD, MN ,&nbsp;Priya Nair MBBS MD, FCICM, PhD","doi":"10.1016/j.ccrj.2024.11.002","DOIUrl":"10.1016/j.ccrj.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The last 15 years have seen a rapid expansion in the use of extracorporeal life support. ECMO has evolved from a rescue treatment available in a few expert centres to an organ support modality for many forms of severe respiratory or cardiovascular failure. There is currently wide variation around the indications for, management of, and systems to support the practice of ECMO. There are few available guidelines on this topic; most have limitations and are not readily generalisable to the Australian or New Zealand healthcare systems.</div></div><div><h3>Methods and analysis</h3><div>This article aims to describe the processes that will be used to produce evidence-based guidelines on the use of ECMO in Australia and New Zealand. The protocol is informed by the National Health and Medical Research Council (NHMRC) Guidelines for Guidelines, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.</div><div>Analysis of available evidence on the identified questions follows a three-phase approach. Firstly, published guidelines will be identified and an assessment of their relevance, methodology and validity carried out. If there are no guidelines on the topic, the second step involves a search and evaluation of systematic reviews. Lastly, a de-novo systematic analysis of primary literature will be undertaken where no systematic reviews are available. The development process will be conducted using the GRADEpro and Covidence software for de novo systematic reviews.</div></div><div><h3>Dissemination</h3><div>The guideline will be published in peer-reviewed journals and summaries will be provided to end-users via the GRADEpro GDT application.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100093"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520940","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":"Excessive vasopressors or excessive hypotension: Searching for the goldilocks zone in mean arterial pressure targets","authors":"Paul J. Young FCICM, PhD,&nbsp;Kyle C. White FCICM, MPH","doi":"10.1016/j.ccrj.2025.100101","DOIUrl":"10.1016/j.ccrj.2025.100101","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100101"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535178","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":"Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: Study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial","authors":"Mahesh Ramanan FCICM, MMed ,&nbsp;Dorrilyn Rajbhandari PGDip Clin Nurs ,&nbsp;Carolyn Koch RN PGDip ICU ,&nbsp;Yasmine Ali Abdelhamid FCICM, FRACP, PhD ,&nbsp;Antony Attokaran FCICM, FRACP, MBBS ,&nbsp;Laurent Billot AStat, MRes ,&nbsp;Severine Bompoint AStat ,&nbsp;Jeremy Cohen FCICM, PhD ,&nbsp;Anthony Delaney FCICM, FACEM, PhD ,&nbsp;Anthony Devaux PhD ,&nbsp;Elif Ekinci FRACP, PhD ,&nbsp;Simon Finfer FCICM, DrMed ,&nbsp;Tessa Garside FCICM, PhD ,&nbsp;Naomi Hammond RN, PhD ,&nbsp;Alisa Higgins PhD ,&nbsp;Gerben Keijzers FACEM, PhD ,&nbsp;Qiang Li AStat, MBiostat ,&nbsp;Benjamin Moran FCICM, FANZCA, MBiostat ,&nbsp;John Myburgh FCICM, PhD ,&nbsp;Priya Nair FCICM, PhD ,&nbsp;Balasubramanian Venkatesh FCICM, MD","doi":"10.1016/j.ccrj.2025.100104","DOIUrl":"10.1016/j.ccrj.2025.100104","url":null,"abstract":"<div><h3>Background</h3><div>The optimal choice of fluid therapy for patients with diabetic ketoacidosis (DKA) is uncertain, though preliminary data suggest that buffered crystalloid solutions (Plasma-Lyte® 148) may offer some advantages over 0.9% saline.</div></div><div><h3>Objective</h3><div>To describe the study protocol for the ‘Balanced Electrolyte Solution versus Saline Trial for Diabetic Ketoacidosis’ (BEST-DKA) trial.</div></div><div><h3>Design, setting and participants</h3><div>BEST-DKA is a Phase 3 cluster-crossover, blinded, pragmatic, randomised, controlled trial comparing the effects of saline or buffered crystalloid solution in patients with moderate to severe DKA treated in the emergency department and/or intensive care unit at twenty hospitals in Australia. Each hospital will be randomised to use either saline or buffered crystalloid solution for a period of 12 months before crossing over to the alternate fluid for the next 12 months. The blinded study fluid will be used for all resuscitation and maintenance purposes for included patients.</div></div><div><h3>Main outcome measures</h3><div>This cluster-randomised, crossover randomised controlled trial (RCT) has been designed with the aim of enrolling a minimum of 400 patients, which will provide &gt;91.4% power to detect a 2-day increase in the primary outcome, days alive and out of hospital to day 28, chosen with consumer representation. Secondary outcomes include quality of life and fatigue scores at day 28, intensive care unit and hospital lengths of stay, acute kidney injury, and time to resolution of DKA. All analyses will be conducted on an intention-to-treat basis. A prespecified statistical analysis plan will be developed prior to interim analysis.</div></div><div><h3>Results and conclusion</h3><div>The BEST-DKA trial commenced enrolment in March 2024 and should generate results that will determine whether treatment with Plasma-Lyte® 148, compared with saline, results in increased days alive, and out of hospital to day 28 for patients with moderate or severe DKA.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100104"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609199","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}