Critical Care and Resuscitation最新文献

{"title":"Decompensated metabolic acidosis in the emergency department: Epidemiology, sodium bicarbonate therapy, and clinical outcomes","authors":"Christopher Guy Dr, MBBS, MPH ,&nbsp;Natasha E. Holmes Associate Professor, MBBS, PhD ,&nbsp;Kartik Kishore Master of Data Science ,&nbsp;Nada Marhoon Post-Graduate Diploma in Data Science ,&nbsp;Ary Serpa-Neto Dr, MD, MSc, PhD","doi":"10.1016/j.ccrj.2023.05.003","DOIUrl":"10.1016/j.ccrj.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>This article aims to describe the epidemiology of decompensated metabolic acidosis, the characteristics of sodium bicarbonate (SB) administration and outcomes in emergency department (ED) patients.</p></div><div><h3>Design</h3><p>This is a retrospective cohort study.</p></div><div><h3>Setting</h3><p>ED of a tertiary referral hospital in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients presenting to the ED between 1 July 2011 and 20 September 2020 with decompensated metabolic acidosis diagnosed on arterial blood gas (ABG).</p></div><div><h3>Main outcome measures</h3><p>We compared characteristics between those treated with or without SB. We studied SB administration characteristics, change in laboratory variables, factors associated with use and dose, and clinical outcomes.</p></div><div><h3>Results</h3><p>Among 753,613 ED patients, 314 had decompensated metabolic acidosis on ABG, with 17.8% receiving SB. Patients in the SB group had lower median pH, CO2, bicarbonate, and base excess (BE) levels compared with the No SB group (<em>P</em> &lt; 0.01). The median number of SB doses in the SB group was one treatment. This was given at a median total dose of 100 mmol and at a median of 2.8 h after the diagnostic blood gas results. Only 42% of patients in the SB group had a subsequent blood gas measured. In such patients, there was no significant change in pH, bicarbonate, or BE. SB therapy was not independently associated with mortality.</p></div><div><h3>Conclusions</h3><p>ABG-confirmed decompensated metabolic acidosis was rare but associated with a high mortality. SB administration occurred in a minority of patients and in more acidaemic patients. However, SB dose was stereotypical and not tailored to acidosis severity. Assessment of SB effect was infrequent and showed no correction of acidosis. Systematic studies of titrated SB therapy are required to inform current practice.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 71-77"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43555338","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":"LOVIT or leave it: The vitamin C debate continues","authors":"Yugeesh R. Lankadeva PhD,&nbsp;Darius JR. Lane PhD,&nbsp;Connie PC. Ow PhD,&nbsp;David A. Story MD, PhD,&nbsp;Mark P. Plummer MD, PhD,&nbsp;Clive N. May PhD","doi":"10.1016/j.ccrj.2023.05.001","DOIUrl":"10.1016/j.ccrj.2023.05.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 63-64"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44551680","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 and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults with sepsis in the intensive care unit (Mega-ROX Sepsis)","authors":"Paul J. Young MBChB, PhD ,&nbsp;Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP ,&nbsp;Diptesh Aryal MD ,&nbsp;Yaseen M. Arabi MD ,&nbsp;Muhammad Sheharyar Ashraf MD ,&nbsp;Sean M. Bagshaw MD, MSc, PhD ,&nbsp;Abigail Beane PhD ,&nbsp;Airton L. de Oliveira Manoel MD, PhD ,&nbsp;Layoni Dullawe Bsc ,&nbsp;Fathima Fazla BSc ,&nbsp;Tomoko Fujii MD, PhD ,&nbsp;Rashan Haniffa PhD ,&nbsp;Carol L. Hodgson PhD, MPhil, PT ,&nbsp;Anna Hunt BN ,&nbsp;Bharath Kumar Tirupakuzhi Vijayaraghavan MD, MSc ,&nbsp;Giovanni Landoni MD ,&nbsp;Cassie Lawrence BN ,&nbsp;Israel Silva Maia MD, MSc ,&nbsp;Diane Mackle MN, PhD ,&nbsp;Mohd Zulfakar Mazlan MBBS, MMed ,&nbsp;Jessica Kasza PhD","doi":"10.1016/j.ccrj.2023.04.008","DOIUrl":"10.1016/j.ccrj.2023.04.008","url":null,"abstract":"<div><h3>Background</h3><p>The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis receiving unplanned invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.</p></div><div><h3>Objective</h3><p>The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Sepsis trial.</p></div><div><h3>Design, setting, and participants</h3><p>The Mega-ROX Sepsis trial is an international randomised clinical trial that will be conducted within an overarching 40,000-patient registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We anticipate that between 10,000 and 13,000 patients with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU will be enrolled in this trial.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome is in-hospital all-cause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of patients discharged home.</p></div><div><h3>Results and conclusions</h3><p>Mega-ROX Sepsis will compare the effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU. The protocol and a prespecified approach to analyses are reported here to mitigate analysis bias.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 106-112"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48037713","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":"Aggression, violence and threatening behaviour during critical illness","authors":"Màiri H. Northcott MBChB ,&nbsp;Gemma Johnston BBioMed MBBS MCritCare ,&nbsp;Jeffrey J. Presneill MBBS(Hons) PhD MBiostat ,&nbsp;Timothy N. Fazio MBBS(Hons) MIS(Health) ,&nbsp;Nathaniel Adamson BNurs, GradCertClinN(CritCare) ,&nbsp;Melissa J. Ankravs BPharm MClinPharm ,&nbsp;Lewis Hackenberger BNurs, GradCertClinN(CritCare) ,&nbsp;Yasmine Ali Abdelhamid MBBS PhD ,&nbsp;Christopher M. MacIsaac MBBS(Hons) PhD MHlthServMt ,&nbsp;Adam M. Deane MBBS PhD","doi":"10.1016/j.ccrj.2023.05.002","DOIUrl":"10.1016/j.ccrj.2023.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>This article aims to quantify prevalence of patient aggression or threatened/actual violence during critical illness.</p></div><div><h3>Design</h3><p>This is a retrospective cohort study.</p></div><div><h3>Setting</h3><p>This study was conducted in single adult trauma intensive care unit (ICU).</p></div><div><h3>Participants</h3><p>Patients aged 18 years or over, admitted between January 2015 and December 2020, who triggered a “Code Grey” response due to aggression or threatened/actual violence.</p></div><div><h3>Main outcome measure</h3><p>The primary outcome was prevalence of Code Grey events. Secondary outcomes included unadjusted and adjusted (logistic mixed model) effects of patient demographics, diagnoses and severity of illness on Code Grey events.</p></div><div><h3>Results</h3><p>There were 16175 ICU admissions relating to 14085 patients and 807 Code Grey events involving 379 (2.7%) patients. The observed count of events increased progressively from 2015 (n = 77) to 2020 (n = 204). For patients with a Code Grey, the median count of events was 3 (range 1–33). Independent predictors of at least one ICU Code Grey event included male sex (OR 2.5; 95% CI 1.8 to 3.4), young age (most elevated odds ratio in patients 20–30 years), admission from the emergency department (OR 2.8, 95% CI 2.1 to 3.6) and a trauma diagnosis (OR 1.4, 95% CI 1.1 to 1.9). Code Grey patients had longer admissions with a reduced risk of death.</p></div><div><h3>Conclusions</h3><p>The prevalence of Code Grey events in ICU appears to be increasing. Patients may have repeated events. Younger male patients admitted to ICU via the emergency department with a trauma or medical diagnosis are at greatest risk of a Code Grey event.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 65-70"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44294145","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":"Gender differences in professional social networks use among critical care researchers.","authors":"Zoé Demailly, Geoffroy Brulard, F. Tamion, B. Veber, E. Occhiali, T. Clavier","doi":"10.2139/ssrn.4208547","DOIUrl":"https://doi.org/10.2139/ssrn.4208547","url":null,"abstract":"BACKGROUND\u0000Recent studies highlight that female anaesthesiology researchers have lower visibility on professional social networks (PSNs) than male researchers.\u0000\u0000\u0000OBJECTIVE\u0000The objective of this work was to compare the use of PSNs between women and men in critical care research.\u0000\u0000\u0000METHODS\u0000We included the first/last authors (FAs/LAs) among the most frequently cited articles in 2018 and 2019 in three critical care journals (Intensive Care Medicine, Critical Care Medicine, and Critical Care). We compared the use of three PSNs-Twitter, ResearchGate, and LinkedIn-between women and men in the FA/LA positions.\u0000\u0000\u0000RESULTS\u0000We analysed 494 articles, which allowed us to include 426 FAs and 383 LAs. The use of a PSN was similar between women and men (Twitter: 35 vs. 31% FA p = 0.76, 38 vs. 31% LA p = 0.24; ResearchGate: 60 vs. 70% FA p = 0.06, 67 vs. 66% LA p = 0.95; LinkedIn: 54 vs. 56% FA p = 0.25, 68 vs. 64% LA p = 0.58; respectively). On ResearchGate, women had a lower reputation score (FA group 26.4 [19.5-31.5] vs. 34.8 [27.4-41.6], p < 0.01; LA group 38.5 [30.9-43.7] vs. 42.3 [37.6-46.4], p < 0.01) and fewer followers (FA group 28.5 [19-45] vs. 68.5 [72,5-657] p < 0.01; LA group 96.5 [43,8-258] vs. 178 [76.3-313.5] p = 0.02). Female researchers were FAs in 30% of the articles and LAs in 16%.\u0000\u0000\u0000CONCLUSION\u0000In the field of critical care, the visibility of female researchers on the social networks dedicated to scientific research is lower than that of male researchers.","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"11 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81734966","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":"Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: An observational study in an intensive care unit","authors":"Sharyn L. Milnes RN, GCCCN, GCHE, GDipEd, MBioeth ,&nbsp;Debra C. Kerr BN MBusL GCResM, GCTerEd PhD ,&nbsp;Ana Hutchinson BN, GDClinEpi, GC-ALL, PhD ,&nbsp;Nicholas B. Simpson MBBS, FACEM, FCICM, DIMC RCSEd, GCHE, PGDipEcho ,&nbsp;Yianni Mantzaridis BMBS ,&nbsp;Charlie Corke MBBS, FCICM ,&nbsp;Michael Bailey PhD, MSc (statistics), BSc (hons), GAICD ,&nbsp;Neil R. Orford MBBS, FANZCA, FCICM, PGDip Echo, PhD","doi":"10.1016/j.ccrj.2023.04.005","DOIUrl":"10.1016/j.ccrj.2023.04.005","url":null,"abstract":"<div><h3>Objectives</h3><p>This article aims to examine the association between a shared decision-making (SDM) clinical communication training program and documentation of SDM for patients with life-limiting illness (LLI) admitted to intensive care.</p></div><div><h3>Methods</h3><p>This article used a prospective, longitudinal observational study in a tertiary intensive care unit (ICU). Outcomes included the proportion of patients with SDM documented on an institutional Goals of Care Form during hospital admission, as well as characteristics, outcomes, and factors associated with an SDM admission.</p></div><div><h3>Intervention</h3><p>Clinical communication skills training (iValidate) and clinical support program are the intervention for this study.</p></div><div><h3>Results</h3><p>A total of 325 patients with LLI were admitted to the ICU and included in the study. Overall, 184 (57%) had an SDM admission, with 79% of Goals of Care Form completed by an iValidate-trained doctor. Exposure to an iValidate-trained doctor was the strongest predictor of an ICU patient with LLI having an SDM admission (odds ratio: 22.72, 95% confidence interval: 11.91–43.54, <em>p</em> &lt; 0.0001). A higher proportion of patients with an SDM admission selected high-dependency unit–level care (29% vs. 12%, <em>p</em> &lt; 0.001) and ward-based care (36% vs. 5%, p &lt; 0.0001), with no difference in the proportion of patients choosing intensive care or palliative care. The proportion of patients with no deterioration plan was higher in the non-SDM admission cohort (59% vs. 0%, <em>p</em> &lt; 0.0001).</p></div><div><h3>Conclusions</h3><p>Clinical communication training that explicitly teaches identification of patient values is associated with improved documentation of SDM for critically ill patients with LLI. Understanding the relationship between improved SDM and patient, family, and clinical outcomes requires appropriately designed high-quality trials randomised at the patient or cluster level.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 1","pages":"Pages 20-26"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41692783","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 protocol for an international, multicentre pharmacokinetic study for Screening Antifungal Exposure in Intensive Care Units: The SAFE-ICU study","authors":"Jason A. Roberts PhD ,&nbsp;Fekade Sime PhD ,&nbsp;Jeffrey Lipman MD ,&nbsp;Maria Patricia Hernández-Mitre PhD ,&nbsp;João Pedro Baptista PhD ,&nbsp;Roger J. Brüggemann PhD ,&nbsp;Jai Darvall PhD ,&nbsp;Jan J. De Waele PhD ,&nbsp;George Dimopoulos PhD ,&nbsp;Jean-Yves Lefrant PhD ,&nbsp;Mohd Basri Mat Nor MD ,&nbsp;Jordi Rello PhD ,&nbsp;Leonardo Seoane MD ,&nbsp;Monica A. Slavin MD ,&nbsp;Miia Valkonen PhD ,&nbsp;Mario Venditti MD ,&nbsp;Wai Tat Wong MD ,&nbsp;Markus Zeitlinger MD ,&nbsp;Claire Roger PhD","doi":"10.1016/j.ccrj.2023.04.002","DOIUrl":"10.1016/j.ccrj.2023.04.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe whether contemporary dosing of antifungal drugs achieves therapeutic exposures in critically ill patients that are associated with optimal outcomes. Adequate antifungal therapy is a key determinant of survival of critically ill patients with fungal infections. Critical illness can alter an antifungal agents’ pharmacokinetics, increasing the risk of inappropriate antifungal exposure that may lead to treatment failure and/or toxicity.</p></div><div><h3>Design, setting and participants</h3><p>This international, multicentre, observational pharmacokinetic study will comprise adult critically ill patients prescribed antifungal agents including fluconazole, voriconazole, posaconazole, isavuconazole, caspofungin, micafungin, anidulafungin, and amphotericin B for the treatment or prophylaxis of invasive fungal disease. A minimum of 12 patients are targeted for enrolment for each antifungal agent, across 12 countries and 30 intensive care units to perform descriptive pharmacokinetics. Pharmacokinetic sampling will occur during two dosing intervals (occasions): firstly, between days 1 and 3, and secondly, between days 4 and 7 of the antifungal course, collecting three samples per occasion. Patients’ demographic and clinical data will be collected.</p></div><div><h3>Main outcome measures</h3><p>The primary endpoint of the study is attainment of pharmacokinetic/pharmacodynamic target exposures that are associated with optimal efficacy. Thirty-day mortality will also be measured.</p></div><div><h3>Results and conclusions</h3><p>This study will describe whether contemporary antifungal drug dosing achieves drug exposures associated with optimal outcomes. Data will also be used for the development of antifungal dosing algorithms for critically ill patients. Optimised drug dosing should be considered a priority for improving clinical outcomes for critically ill patients with fungal infections.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 1","pages":"Pages 1-5"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43354176","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":"Clinical Informatics needs to be a competency for Intensive care training","authors":"Sing Chee Tan FCICM MBBS ,&nbsp;Tess Evans MBBS ,&nbsp;Tamishta Hensman MBBS ,&nbsp;Matthew Durie FCICM FANZCA MBBS ,&nbsp;Paul Secombe FCICM MBBS, DP ,&nbsp;David Pilcher FCICM MBBS","doi":"10.1016/j.ccrj.2023.04.003","DOIUrl":"10.1016/j.ccrj.2023.04.003","url":null,"abstract":"<div><p>Clinical informatics is a cornerstone in the delivery of safe and quality critical care in Australia and New Zealand. Recent advances in the field of clinical informatics, including new technologies that digitise healthcare data, improved methods of capturing and storing these data, as well as innovative analytic methods using machine learning and artificial intelligence, present exciting new opportunities to leverage data for improving the delivery of critical care and patient outcomes. However, ICU training in Australian and New Zealand does not adequately address capability gaps in this area, potentially leaving future intensivists without the necessary skills to provide leadership in the application of informatics within ICUs. This highlights the need to examine how competency in clinical informatics can be incorporated into ICU training, potentially through a range of activities such as curriculum redesign, the formal project, and workshops or datathons. Further work to identify relevant informatics competencies and methods to develop and assess these competencies within ICU training is needed.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 1","pages":"Pages 6-8"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48546872","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":"Perioperative dexmedetomidine compared to midazolam in children undergoing open-heart surgery: A pilot randomised controlled trial","authors":"Debbie A. Long RN, PhD ,&nbsp;Kristen S. Gibbons PhD ,&nbsp;Christian Stocker MD, FCICM ,&nbsp;Michael Ranger MBCHB, FANZCA ,&nbsp;Nelson Alphonso MD ,&nbsp;Renate Le Marsney MPH ,&nbsp;Belinda Dow BA(Psych)Hons, PhD ,&nbsp;Jessica A. Schults RN, PhD ,&nbsp;Cameron Graydon MBBS, FANZCA ,&nbsp;Yahya Shehabi MBBS, PhD, FCICM, FANZCA ,&nbsp;Andreas Schibler MD, FCICM","doi":"10.1016/j.ccrj.2023.04.007","DOIUrl":"10.1016/j.ccrj.2023.04.007","url":null,"abstract":"<div><h3>Objective</h3><p>There is a need for evidence on the best sedative agents in children undergoing open heart surgery for congenital heart disease. This study aimed to evaluate the feasibility and safety of dexmedetomidine in this group compared with midazolam.</p></div><div><h3>Design</h3><p>Double blinded, pilot randomized controlled trial.</p></div><div><h3>Setting</h3><p>Cardiac operating theatre and paediatric intensive care unit in Brisbane, Australia.</p></div><div><h3>Participants</h3><p>Infants (≤12 months of age) undergoing their first surgical repair of a congenital heart defect.</p></div><div><h3>Interventions</h3><p>Dexmedetomidine (up to 1.0mcg/kg/hr) versus midazolam (up to 80mcg/kg/hr), commenced in the cardiac operating theatre prior to surgery.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome was the time spent in light sedation (Sedation Behavior Scale [SBS] -1 to +1); Co-primary feasibility outcome was recruitment, retention and protocol adherence. Secondary outcomes were use of supplemental sedatives, ventilator free days, delirium, vasoactive drug support, and adverse events. Neurodevelopment and health-related quality of life (HRQoL) were assessed at 12 months post-surgery.</p></div><div><h3>Results</h3><p>Sixty-six participants were recruited. The number of SBS scores in the light sedation range were greater in the dexmedetomidine group at 24 hours, 48 hours, and overall study duration (0-14 days) versus the midazolam group (24hr: 76/170 [45%] vs 60/178 [34%], aOR 4.14 [95% CI 0.48, 35.92]; 48hr: 154/298 [52%] vs 122/314 [39%], aOR 6.95 [95% CI 0.77, 63.13]; 0-14 days: 597/831 [72%] vs 527/939 [56%], aOR 3.93 [95% CI 0.62, 25.03]). Feasibility was established with no withdrawals or loss to follow-up at 14 days and minimal protocol deviations. There were no differences between the groups relating to clinical, safety, neurodevelopment or HRQoL outcomes.</p></div><div><h3>Conclusions</h3><p>The use of dexmedetomidine was associated with more time spent in light sedation when compared with midazolam. The feasibility of conducting a blinded RCT of midazolam and dexmedetomidine in children undergoing open heart surgery was also established. The findings justify further investigation in a larger trial.</p></div><div><h3>Clinical trial registration</h3><p>ACTRN12615001304527.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 1","pages":"Pages 33-42"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47934496","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":"Thirty years of ANZICS CORE: A clinical quality success story","authors":"Paul Secombe BMBS(hons) ,&nbsp;Johnny Millar PhD ,&nbsp;Edward Litton PhD ,&nbsp;Shaila Chavan ,&nbsp;Tamishta Hensman MBBS ,&nbsp;Graeme K. Hart MBBS ,&nbsp;Anthony Slater MBBS ,&nbsp;Robert Herkes MBBS ,&nbsp;Sue Huckson ,&nbsp;David V. Pilcher MBBS","doi":"10.1016/j.ccrj.2023.04.009","DOIUrl":"10.1016/j.ccrj.2023.04.009","url":null,"abstract":"<div><p>In 2023, the Australian and New Zealand Intensive Care Society (ANZICS) Registry run by the Centre for Outcomes and Resources Evaluation (CORE) turns 30 years old. It began with the Adult Patient Database, the Australian and New Zealand Paediatric Intensive Care Registry, and the Critical Care Resources Registry, and it now includes Central Line Associated Bloodstream Infections Registry, the Extra-Corporeal Membrane Oxygenation Database, and the Critical Health Resources Information System. The ANZICS Registry provides comparative case-mix reports, risk-adjusted clinical outcomes, process measures, and quality of care indicators to over 200 intensive care units describing more than 200 000 adult and paediatric admissions annually. The ANZICS CORE outlier management program has been a major contributor to the improved patient outcomes and provided significant cost savings to the healthcare sector. Over 200 peer-reviewed papers have been published using ANZICS Registry data. The ANZICS Registry was a vital source of information during the COVID-19 pandemic. Upcoming developments include reporting of long-term survival and patient-reported outcome and experience measures.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 1","pages":"Pages 43-46"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42005636","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}