Critical Care and Resuscitation最新文献

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Olanzapine versus quetiapine in critically ill patients with hyperactive delirium: Protocol for a multicentre, cluster-randomised, double-crossover, pragmatic clinical trial (CALM-ICU). 奥氮平与喹硫平在危重症多活动性谵妄患者中的应用:多中心、集群随机、双交叉、实用临床试验(CALM-ICU)的方案
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-11-22 eCollection Date: 2024-12-01 DOI: 10.1016/j.ccrj.2024.08.003
Melissa J Ankravs, Andrew Udy, Rinaldo Bellomo, Jeffrey J Presneill, Laura Adams, Yasmine Ali Abdelhamid, Michael Bailey, Jasmin Board, Kathleen Byrne, Glenn Eastwood, Maurice Le Guen, Emma-Leah Martin, Mark P Plummer, Megan Richardson, Lucy Sharrock, Meredith Young, Adam M Deane
{"title":"Olanzapine versus quetiapine in critically ill patients with hyperactive delirium: Protocol for a multicentre, cluster-randomised, double-crossover, pragmatic clinical trial (CALM-ICU).","authors":"Melissa J Ankravs, Andrew Udy, Rinaldo Bellomo, Jeffrey J Presneill, Laura Adams, Yasmine Ali Abdelhamid, Michael Bailey, Jasmin Board, Kathleen Byrne, Glenn Eastwood, Maurice Le Guen, Emma-Leah Martin, Mark P Plummer, Megan Richardson, Lucy Sharrock, Meredith Young, Adam M Deane","doi":"10.1016/j.ccrj.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.</p><p><strong>Objective: </strong>The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.</p><p><strong>Design setting participants and interventions: </strong>This is a cluster-randomised, double-crossover, clinical trial. Critically ill adult patients admitted to three tertiary Australian intensive care units over a 12-month period will be eligible. Randomisation will occur at the site level, with allocation to open-label olanzapine or quetiapine use over four treatment periods of 3-month duration.</p><p><strong>Main outcome measure: </strong>The primary outcome and days alive and delirium-/coma-free (censored at 14 days post enrolment) will be analysed using median quantile regression accounting for clustering at sites' level and time period and treatment order.</p><p><strong>Results and conclusion: </strong>This trial will compare the effect of enteral olanzapine to quetiapine in critically ill adults with hyperactive delirium on an important indicator of patient outcome.</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"249-254"},"PeriodicalIF":1.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957633","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}
引用次数: 0
Severe intensive care unit-acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome. 重症监护病房获得性高钠血症:患病率、危险因素、发展轨迹、管理和结果。
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-11-22 eCollection Date: 2024-12-01 DOI: 10.1016/j.ccrj.2024.09.004
Anis Chaba, Atthaphong Phongphithakchai, Oscar Pope, Sam Rajapaksha, Pratibha Ranjan, Akinori Maeda, Sofia Spano, Yukiko Hikasa, Glenn Eastwood, Nuttapol Pattamin, Nuanprae Kitisin, Ahmad Nasser, Kyle C White, Rinaldo Bellomo
{"title":"Severe intensive care unit-acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome.","authors":"Anis Chaba, Atthaphong Phongphithakchai, Oscar Pope, Sam Rajapaksha, Pratibha Ranjan, Akinori Maeda, Sofia Spano, Yukiko Hikasa, Glenn Eastwood, Nuttapol Pattamin, Nuanprae Kitisin, Ahmad Nasser, Kyle C White, Rinaldo Bellomo","doi":"10.1016/j.ccrj.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>Severe intensive care unit-acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.</p><p><strong>Objectives: </strong>The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L<sup>-1</sup>).</p><p><strong>Methods: </strong>A retrospective study was conducted in a 40-bed ICU in a university-affiliated hospital. Assessment of sodium levels, factors associated with severe ICU-AH, urinary electrolyte measurements, water therapy, fluid balance, correction rate, and delirium was made.</p><p><strong>Results: </strong>We screened 11,642 ICU admissions and identified 109 patients with severe ICU-AH. The median age was 57 years, 63% were male, and the median Acute Physiology and Chronic Health Evaluation III score was 64 (52; 80). On the day of ICU admission, 64% of patients were ventilated; 71% received vasopressors, and 22% had acute kidney injury. The median peak sodium level was 158 (156; 161) mmolL<sup>-1</sup> at a median of 4 (1; 11) days after ICU admission. Only eight patients (7%) had urine sodium measurement (median concentration: 17 mmol·L<sup>-1</sup>). On the day of peak hypernatraemia, 80% of patients were unable to drink due to invasive ventilation; 34% were on diuretics; 25% had fever, and 50% did not receive hypotonic fluids. When available, the median electrolyte-free water clearance was -1.1 L (-1.7; -0.5), representing half of the urine output. After peak hypernatraemia, the correction rate was -2.8 mmol·L<sup>-1</sup> per day (95% confidence interval: [-2.9 to -2.6]) during the first 3 d.</p><p><strong>Conclusions: </strong>Severe hypernatraemia occurred in the setting of inability to drink, near-absent measurement of urinary free water losses, diuretic therapy, fever, renal impairment, and near-absent or limited or delayed water administration. Correction was slow.</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"311-318"},"PeriodicalIF":1.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957646","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}
引用次数: 0
Long-term outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest: Analysis of EXCEL registry data. 院内心脏骤停后接受体外心肺复苏(ECPR)患者的长期结局:EXCEL注册数据分析
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-11-21 eCollection Date: 2024-12-01 DOI: 10.1016/j.ccrj.2024.08.008
G Pound, D Jones, G M Eastwood, E Paul, A Serpa Neto, C L Hodgson
{"title":"Long-term outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest: Analysis of EXCEL registry data.","authors":"G Pound, D Jones, G M Eastwood, E Paul, A Serpa Neto, C L Hodgson","doi":"10.1016/j.ccrj.2024.08.008","DOIUrl":"10.1016/j.ccrj.2024.08.008","url":null,"abstract":"<p><strong>Objective: </strong>To describe the six-month functional outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA) in Australia.</p><p><strong>Design: </strong>Secondary analysis of EXCEL registry data.</p><p><strong>Setting: </strong>EXCEL is a high-quality, prospective, binational registry including adult patients who receive extracorporeal membrane oxygenation (ECMO) in Australia and New Zealand.</p><p><strong>Participants: </strong>Patients reported to the EXCEL registry who received ECPR following IHCA and had the six-month outcome data available were included.</p><p><strong>Main outcome measures: </strong>The primary outcome was functional outcome at six months measured using the modified Rankin scale (mRS). The secondary outcomes included mortality, disability, health status, and complications.</p><p><strong>Results: </strong>Between 15th February 2019 and 31st August 2022, 113/1251 (9.0%) patients in the registry received ECPR following IHCA (mean age 50.7 ± 13.7 years; 79/113 (69.9%) male; 74/113 (65.5%) non-shockable rhythm). At 6 months, 37/113 (32.7%) patients were alive, most (27/34 [79.4%]) with a good functional outcome (mRS 0-3). Patients had increased disability [WHODAS % Score 25.58 ± 23.39% vs 6.45 ± 12.32%; mean difference (MD) [95% (confidence interval) CI] -19.13 (-28.49 to -9.77); <i>p</i> < 0.001] and worse health status [EuroQol five-dimension, five-level (EQ-5D-5L) index value 0.73 ± 0.23 vs. 0.89 ± 0.14; MD (95% CI) 0.17 (0.07 to 0.26); <i>p</i> = 0.003] at six months compared with the baseline. The patients reported a median of 4.5 (2-6) complications at six-month follow-up.</p><p><strong>Conclusion: </strong>One in three patients who received ECPR following IHCA were alive at six months and most had a good functional outcome. However, survivors reported higher levels of disability and a worse health status at six months compared with the baseline and ongoing complications were common.</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"279-285"},"PeriodicalIF":1.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014831","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}
引用次数: 0
A comparison of anti-coagulation monitoring tests in ICU patients receiving a continuous infusion of unfractionated heparin. ICU患者连续输注无分离肝素抗凝监测试验的比较。
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-11-21 eCollection Date: 2024-12-01 DOI: 10.1016/j.ccrj.2024.08.004
Sofia Spano, Akinori Maeda, Anis Chaba, Glenn Eastwood, Maninder Randhawa, Christopher Hogan, Rinaldo Bellomo, Stephen Warrillow
{"title":"A comparison of anti-coagulation monitoring tests in ICU patients receiving a continuous infusion of unfractionated heparin.","authors":"Sofia Spano, Akinori Maeda, Anis Chaba, Glenn Eastwood, Maninder Randhawa, Christopher Hogan, Rinaldo Bellomo, Stephen Warrillow","doi":"10.1016/j.ccrj.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.08.004","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"255-261"},"PeriodicalIF":1.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957516","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}
引用次数: 0
The effect of early intravenous amino acid supplementation in critically ill patients without acute kidney injury: Protocol for a multicentre, randomised, parallel-controlled trial (the ESSENTIAL trial). 早期静脉补充氨基酸对无急性肾损伤危重患者的影响:多中心、随机、平行对照试验方案(ESSENTIAL试验)
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-11-20 eCollection Date: 2024-12-01 DOI: 10.1016/j.ccrj.2024.10.002
Lingliang Zhou, Gordon S Doig, Cheng Lv, Lu Ke, Weiqin Li
{"title":"The effect of early intravenous amino acid supplementation in critically ill patients without acute kidney injury: Protocol for a multicentre, randomised, parallel-controlled trial (the ESSENTIAL trial).","authors":"Lingliang Zhou, Gordon S Doig, Cheng Lv, Lu Ke, Weiqin Li","doi":"10.1016/j.ccrj.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.10.002","url":null,"abstract":"<p><strong>Objective: </strong>There is uncertainty about whether early infusion of intravenous amino acids confers clinical benefits in critically ill patients. In this study, we aimed to test the hypothesis that intravenous amino acids could improve 90-day mortality in critically ill patients with normal kidney function.</p><p><strong>Design: </strong>This is a multicentre, open-label, randomised, parallel-controlled trial.</p><p><strong>Setting: </strong>20 ICUs across China.</p><p><strong>Participants: </strong>1928 eligible critically ill patients with normal kidney function.</p><p><strong>Interventions: </strong>In addition to standard care, patients assigned to the intervention group will receive a continuous infusion of amino acids at a rate to achieve a total daily protein intake of approximately 2.0 g/kg/day.</p><p><strong>Main outcome measures: </strong>The primary endpoint is all-cause mortality at day 90 after randomisation. Secondary endpoints and process measures will also be reported. The primary conclusions will be based on a modified intention-to-treat analysis for efficacy.</p><p><strong>Ethics and dissemination: </strong>This study was approved by the ethics committee of the Jinling Hospital, Nanjing University (2020-NZKY-014-02 for the original version and 2020-NZKY-014-06 for the revised version) and all the participating sites. Results will be disseminated through journal publications and conference presentations.</p><p><strong>Registration: </strong>This study protocol was registered with the Chinese Clinical Trial Registry, and the identifier is ChiCTR2100053359 (https://www.chictr.org.cn/hvshowprojectEN.html?id=257327&v=1.7).</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"326-331"},"PeriodicalIF":1.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957648","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}
引用次数: 0
Natural language processing in the intensive care unit: A scoping review 重症监护室的自然语言处理:范围综述
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.06.008
Julia K. Pilowsky RN, PhD , Jae-Won Choi MBiomedE, BE (Comp), BE-Health (HI) (ProfHons) , Aldo Saavedra PhD , Maysaa Daher BPsych, MAppStats , Nhi Nguyen MBBS, FCICM , Linda Williams RN, MHealthManagement , Sarah L. Jones RN, Grad Dip Ed (Nursing), Grad Cert (ICU)
{"title":"Natural language processing in the intensive care unit: A scoping review","authors":"Julia K. Pilowsky RN, PhD ,&nbsp;Jae-Won Choi MBiomedE, BE (Comp), BE-Health (HI) (ProfHons) ,&nbsp;Aldo Saavedra PhD ,&nbsp;Maysaa Daher BPsych, MAppStats ,&nbsp;Nhi Nguyen MBBS, FCICM ,&nbsp;Linda Williams RN, MHealthManagement ,&nbsp;Sarah L. Jones RN, Grad Dip Ed (Nursing), Grad Cert (ICU)","doi":"10.1016/j.ccrj.2024.06.008","DOIUrl":"10.1016/j.ccrj.2024.06.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Natural language processing (NLP) is a branch of artificial intelligence focused on enabling computers to interpret and analyse text-based data. The intensive care specialty is known to generate large volumes of data, including free-text, however, NLP applications are not commonly used either in critical care clinical research or quality improvement projects. This review aims to provide an overview of how NLP has been used in the intensive care specialty and promote an understanding of NLP's potential future clinical applications.</p></div><div><h3>Design</h3><p>Scoping review.</p></div><div><h3>Data sources</h3><p>A systematic search was developed with an information specialist and deployed on the PubMed electronic journal database. Results were restricted to the last 10 years to ensure currency.</p></div><div><h3>Review methods</h3><p>Screening and data extraction were undertaken by two independent reviewers, with any disagreements resolved by a third. Given the heterogeneity of the eligible articles, a narrative synthesis was conducted.</p></div><div><h3>Results</h3><p>Eighty-seven eligible articles were included in the review. The most common type (n = 24) were studies that used NLP-derived features to predict clinical outcomes, most commonly mortality (n = 16). Next were articles that used NLP to identify a specific concept (n = 23), including sepsis, family visitation and mental health disorders. Most studies only described the development and internal validation of their algorithm (n = 79), and only one reported the implementation of an algorithm in a clinical setting.</p></div><div><h3>Conclusions</h3><p>Natural language processing has been used for a variety of purposes in the ICU context. Increasing awareness of these techniques amongst clinicians may lead to more clinically relevant algorithms being developed and implemented.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 210-216"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000243/pdfft?md5=baca71f4ef8b264efa157f45c9f3f932&pid=1-s2.0-S1441277224000243-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230444","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}
引用次数: 0
Response to: “More than one pathway: ECMO training and credentialing” 回应:"不止一条途径:ECMO 培训和资格认证"
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.07.001
Stuart C. Duffin BMedSci, MBBS, FCICM, DESA, EDIC, Judith H. Askew BAppSci, MBBS, FCICM, Timothy J. Southwood MBBS, MSc, FCICM, Paul Forrest MBCHB, FANZCA, Brian Plunkett MBChB, FRACS, Richard J. Totaro MBBS, FRACP, FCICM
{"title":"Response to: “More than one pathway: ECMO training and credentialing”","authors":"Stuart C. Duffin BMedSci, MBBS, FCICM, DESA, EDIC,&nbsp;Judith H. Askew BAppSci, MBBS, FCICM,&nbsp;Timothy J. Southwood MBBS, MSc, FCICM,&nbsp;Paul Forrest MBCHB, FANZCA,&nbsp;Brian Plunkett MBChB, FRACS,&nbsp;Richard J. Totaro MBBS, FRACP, FCICM","doi":"10.1016/j.ccrj.2024.07.001","DOIUrl":"10.1016/j.ccrj.2024.07.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 219"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000267/pdfft?md5=b7e7d7886f372d75e1216e260de71fe2&pid=1-s2.0-S1441277224000267-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230447","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}
引用次数: 0
Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study 澳大利亚和新西兰严重急性呼吸窘迫综合征的管理(SAGE-ANZ):观察研究
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.05.001
Rachael L. Parke RN, PhD , Shay P. McGuinness MBChB , Alana Cavadino PhD , Keri-Anne Cowdrey RN, MN , Samantha Bates RN, MN , Shailesh Bihari MBBS, PhD , Amanda Corley RN, PhD , Eileen Gilder RN, PhD , Carol Hodgson PhD , Edward Litton MBChB, PhD , Colin McArthur MBChB , Alistair Nichol MBBCh, PhD , Jane Parker RN, MPH , Anne Turner RN, MPH , Steve Webb MBBS, PhD , Frank MP. Van Haren MD, PhD , SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group
{"title":"Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study","authors":"Rachael L. Parke RN, PhD ,&nbsp;Shay P. McGuinness MBChB ,&nbsp;Alana Cavadino PhD ,&nbsp;Keri-Anne Cowdrey RN, MN ,&nbsp;Samantha Bates RN, MN ,&nbsp;Shailesh Bihari MBBS, PhD ,&nbsp;Amanda Corley RN, PhD ,&nbsp;Eileen Gilder RN, PhD ,&nbsp;Carol Hodgson PhD ,&nbsp;Edward Litton MBChB, PhD ,&nbsp;Colin McArthur MBChB ,&nbsp;Alistair Nichol MBBCh, PhD ,&nbsp;Jane Parker RN, MPH ,&nbsp;Anne Turner RN, MPH ,&nbsp;Steve Webb MBBS, PhD ,&nbsp;Frank MP. Van Haren MD, PhD ,&nbsp;SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.ccrj.2024.05.001","DOIUrl":"10.1016/j.ccrj.2024.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice.</p></div><div><h3>Design</h3><p>Bi-national, prospective, observational, multi-centre study.</p></div><div><h3>Setting</h3><p>19 ICUs in Australia and New Zealand.</p></div><div><h3>Participants</h3><p>Mechanically ventilated patients with moderate-severe ARDS.</p></div><div><h3>Main outcome measures</h3><p>Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.</p></div><div><h3>Results</h3><p>200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO<sub>2</sub>/FiO<sub>2</sub> ratio 119 (89, 142), median (IQR) FiO<sub>2</sub> 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH<sub>2</sub>O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H<sub>2</sub>O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61).</p></div><div><h3>Conclusions</h3><p>In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 161-168"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000139/pdfft?md5=d534b9440be94c4ac8edd575b084a64d&pid=1-s2.0-S1441277224000139-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230330","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}
引用次数: 0
Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence 中重度创伤性脑损伤的脑组织氧监测:生理决定因素、临床干预措施和当前随机对照试验证据
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.05.003
Toby Jeffcote FCICM, PhD , Kuan-Ying Lu MBiomedEng , Philip Lewis PhD , Dashiell Gantner FCICM, PhD , Camila R. Battistuzzo PhD , Andrew A. Udy FCICM, PhD
{"title":"Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence","authors":"Toby Jeffcote FCICM, PhD ,&nbsp;Kuan-Ying Lu MBiomedEng ,&nbsp;Philip Lewis PhD ,&nbsp;Dashiell Gantner FCICM, PhD ,&nbsp;Camila R. Battistuzzo PhD ,&nbsp;Andrew A. Udy FCICM, PhD","doi":"10.1016/j.ccrj.2024.05.003","DOIUrl":"10.1016/j.ccrj.2024.05.003","url":null,"abstract":"<div><p>Modern intensive care for moderate-to-severe traumatic brain injury (msTBI) focuses on managing intracranial pressure (ICP) and cerebral perfusion pressure (CPP). This approach lacks robust clinical evidence and often overlooks the impact of hypoxic injuries. Emerging monitoring modalities, particularly those capable of measuring brain tissue oxygen, represent a promising avenue for advanced neuromonitoring. Among these, brain tissue oxygen tension (PbtO<sub>2</sub>) shows the most promising results. However, there is still a lack of consensus regarding the interpretation of PbtO<sub>2</sub> in clinical practice. This review aims to provide an overview of the pathophysiological rationales, monitoring technology, physiological determinants, and recent clinical trial evidence for PbtO<sub>2</sub> monitoring in the management of msTBI.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 204-209"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000152/pdfft?md5=e58a24cff9d40d7de6e006570777fc6b&pid=1-s2.0-S1441277224000152-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230443","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}
引用次数: 0
ARDS, guidelines and ANZ practice: The persistent disconnect ARDS、指南和澳新实践:长期脱节
IF 1.4 4区 医学
Critical Care and Resuscitation Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.08.005
Ary Serpa Neto MD, MSc, PhD
{"title":"ARDS, guidelines and ANZ practice: The persistent disconnect","authors":"Ary Serpa Neto MD, MSc, PhD","doi":"10.1016/j.ccrj.2024.08.005","DOIUrl":"10.1016/j.ccrj.2024.08.005","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 159-160"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000322/pdfft?md5=4c206667cb8d6cc357879153406c2ecc&pid=1-s2.0-S1441277224000322-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230329","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}
引用次数: 0
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