Critical Care and Resuscitation最新文献

{"title":"A retrospective registry-based study into the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their outcomes in Australia and New Zealand","authors":"Zheng Jie Lim (Zee) MBBS (Hons), MMed Periop ,&nbsp;Dharshi Karalapillai MBBS, PhD, FANZCA, FCICM, PGDipUS ,&nbsp;Helen Kolawole BMedSc, MBBS, MClinEd, FANZCA ,&nbsp;Chris Fiddes MBBS, FANZCA ,&nbsp;David Pilcher MBBS, MRCP, FRACP, FCICM ,&nbsp;Ashwin Subramaniam MBBS, MMed, GChPOM, FRACP, FCICM, PhD","doi":"10.1016/j.ccrj.2024.06.002","DOIUrl":"10.1016/j.ccrj.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their subsequent outcomes in Australia and New Zealand.</p></div><div><h3>Design</h3><p>Retrospective observational study of ICU admissions for severe anaphylaxis.</p></div><div><h3>Setting</h3><p>ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2022.</p></div><div><h3>Participants</h3><p>Adults 16 years or older with severe anaphylaxis admitted to the ICU.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main outcome measures</h3><p>Proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis, mortality rate, ICU and hospital length of stay.</p></div><div><h3>Results</h3><p>7189 of the 7270 ICU admissions for severe anaphylaxis recorded between 2012 and 2022, were included in the analysis. This represented a proportion from 0.25% in 2012 to 0.43% in 2022. ICU and hospital mortality were 0.4% and 0.8%, respectively. The proportion of ICUs reporting at least one severe anaphylaxis each year increased from 61.7% in 2012 to 83.0% in 2022. Most of the patients were discharged home (92.6%, n = 6660). Increasing age (OR = 1.055; 95%CI: 1.008–1.105) and SOFA scores (OR = 1.616; 95%CI: 1.265–2.065), an immunosuppressive chronic condition (OR = 16.572; 95%CI: 3.006–91.349) and an increasing respiratory rate above 16 breaths/min (OR = 1.116; 95%CI: 1.057–1.178) predicted in-hospital mortality in patients with anaphylaxis, while higher GCS decreased in-hospital mortality (OR = 0.827; 95%CI: 0.705–0.969).</p></div><div><h3>Conclusions</h3><p>The overall proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis has increased. In-hospital mortality remains low despite the need for vital organ support. Further studies should investigate these identified factors that may predict in-hospital mortality among these patients.</p></div><div><h3>Trial registration</h3><p>Not applicable.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 185-191"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000176/pdfft?md5=f3d17dbf6c2d76f42f55e0c44acee7cb&pid=1-s2.0-S1441277224000176-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230347","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":"More than one pathway: ECMO training and credentialing","authors":"Michael Kouch M.D,&nbsp;Nitin Puri M.D,&nbsp;Emily Damuth M.D,&nbsp;Christopher Noel M.D,&nbsp;Jason Bartock M.D,&nbsp;Adam Green M.D","doi":"10.1016/j.ccrj.2024.06.004","DOIUrl":"10.1016/j.ccrj.2024.06.004","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 217-218"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722400019X/pdfft?md5=a864133d5162fcfea509a90639d0efe9&pid=1-s2.0-S144127722400019X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230445","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":"Point-of-care creatinine vs. central laboratory creatinine in the critically ill","authors":"Kyle C. White FCICM, MPH ,&nbsp;James McCullough FCICM, MMed ,&nbsp;Kiran Shekar FCICM, PhD ,&nbsp;Siva Senthuran FCICM, MBBS ,&nbsp;Kevin B. Laupland FCICM, PhD ,&nbsp;Goce Dimeski BSc Med Lab, PhD ,&nbsp;Ary Serpa-Neto FCICM, PhD ,&nbsp;Rinaldo Bellomo MD, PhD ,&nbsp;Queensland Critical Care Research Network (QCRCN)","doi":"10.1016/j.ccrj.2024.07.002","DOIUrl":"10.1016/j.ccrj.2024.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>Frequent measurement of creatinine by point-of-care testing (POCT) may facilitate the earlier detection of acute kidney injury (AKI) in critically ill patients. However, no robust data exist to confirm its equivalence to central laboratory testing. We aimed to conduct a multicenter study to compare POCT with central laboratory creatinine (CrC) measurement.</p></div><div><h3>Design</h3><p>Retrospective observational study, using hospital electronic medical records. Obtained paired point-of-care creatinine (CrP) from arterial blood gas machines and CrC.</p></div><div><h3>Setting</h3><p>Four intensive care units in Queensland, Australia.</p></div><div><h3>Participants</h3><p>Critically ill patients, where greater than 50% of POCT contained creatinine.</p></div><div><h3>Main outcome measures</h3><p>Mean difference, bias, and limits of agreement between two methods, and biochemical confounders.</p></div><div><h3>Results</h3><p>We studied 79,767 paired measurements in 19,118 patients, with a median Acute Physiology and Chronic Health Evaluation 3 score of 51. The mean CrC was 115.5 μmol/L (standard deviation: 100.2) compared to a CrP mean of 115 μmol/L (standard deviation: 100.7) (Pearson coefficient of 0.99). The mean difference between CrP and CrC was 0.49 μmol/L with 95% limits of agreement of −27 μmol/L and +28 μmol/L. Several biochemical variables were independently associated with the difference between tests (e.g., pH, potassium, lactate, glucose, and bilirubin), but their impact was small.</p></div><div><h3>Conclusion</h3><p>In critically ill patients, measurement of creatinine by POCT yields clinically equivalent values to those obtained by central laboratory measurement and can be easily used for more frequent monitoring of kidney function in such patients. These findings open the door to the use of POCT for the earlier detection of acute kidney injury in critically ill patients.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 198-203"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000279/pdfft?md5=fe53682e5d2e5687b85d3ba807712d31&pid=1-s2.0-S1441277224000279-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230446","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":"The cost of coffee","authors":"Amelia Elizabeth Street","doi":"10.1016/j.ccrj.2024.06.005","DOIUrl":"10.1016/j.ccrj.2024.06.005","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 220"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000218/pdfft?md5=ce44d934335dbe211fbfeb6b1a11cce2&pid=1-s2.0-S1441277224000218-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230448","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":"Perspectives on healing: Therapy dog","authors":"Martina Zib","doi":"10.1016/j.ccrj.2024.06.006","DOIUrl":"10.1016/j.ccrj.2024.06.006","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 221"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000231/pdfft?md5=3f78bae756ce83ee3336680a53ebb91e&pid=1-s2.0-S1441277224000231-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230449","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":"Sonographic evaluation of intracranial hemodynamics and pressure after out-of-hospital cardiac arrest: An exploratory sub-study of the TAME trial","authors":"Halvor Ø. Guldbrandsen MD ,&nbsp;Peter Juhl-Olsen MD, PhD ,&nbsp;Glenn M. Eastwood MD, PhD ,&nbsp;Kasper L. Wethelund BMSc ,&nbsp;Anders M. Grejs MD, PhD","doi":"10.1016/j.ccrj.2024.06.001","DOIUrl":"10.1016/j.ccrj.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>Targeted mild hypercapnia is a potential neuroprotective therapy after cardiac arrest. In this exploratory observational study, we aimed to explore the effects of targeted mild hypercapnia on cerebral microvascular resistance assessed by middle cerebral artery pulsatility index (MCA PI) and intracranial pressure estimated by optic nerve sheath diameter (ONSD) in resuscitated out-of-hospital cardiac arrest (OHCA) patients.</p></div><div><h3>Design, setting, participants and interventions</h3><p>Comatose adults resuscitated from OHCA were randomly allocated to targeted mild hypercapnia (PaCO₂ 50–55 mmHg) or targeted normocapnia (PaCO₂ 35–45 mmHg) for 24 h in the TAME trial.</p></div><div><h3>Main outcome measures</h3><p>Using transcranial Doppler and transorbital ultrasound, we obtained MCA PI and ONSD at 4, 24, and 48 h after randomization. Ultrasound parameters were compared between groups using a linear mixed effects model.</p></div><div><h3>Results</h3><p>Twelve consecutive patients were included, with seven patients in the mild hypercapnia group. MCA PI decreased from 4 to 24 h (p = 0.019) and was lower over the first 24 h in patients allocated to targeted mild hypercapnia compared with targeted normocapnia (p = 0.047). ONSD did not differ between groups or over time.</p></div><div><h3>Conclusion</h3><p>Cerebral microvascular resistance assessed by MCA PI decreased over 24 h and was lower in OHCA patients treated with targeted mild hypercapnia compared with targeted normocapnia. Targeted mild hypercapnia did not exert substantial effect on intracranial pressure as estimated by ONSD.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 176-184"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000164/pdfft?md5=f7af3cbe49d6aa5ac5495abd615c7474&pid=1-s2.0-S1441277224000164-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230346","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 multicentre point prevalence study of nocturnal hours awake and enteral pharmacological sleep aids in patients admitted to Australian and New Zealand intensive care units","authors":"Laurie Showler MBChB ,&nbsp;Adam M. Deane MBBS PhD ,&nbsp;Edward Litton MBChB MSc ,&nbsp;Melissa J. Ankravs BPharm MClinPharm ,&nbsp;Bradley Wibrow MBBS MSc ,&nbsp;Deborah Barge RN RM CCRN ,&nbsp;Jeremy Goldin MBBS MM ,&nbsp;Naomi Hammond RN MN PhD ,&nbsp;Manoj K. Saxena MMBChir BSc ,&nbsp;Paul J. Young MBChB PhD ,&nbsp;Bala Venkatesh MBBS MD ,&nbsp;Mark Finnis MBBS MBiostat ,&nbsp;Yasmine Ali Abdelhamid MBBS PhD","doi":"10.1016/j.ccrj.2024.06.009","DOIUrl":"10.1016/j.ccrj.2024.06.009","url":null,"abstract":"<div><h3>Objective</h3><p>Critically ill patients suffer disrupted sleep. Hypnotic medications may improve sleep; however, local epidemiological data regarding the amount of nocturnal time awake and the use of such medications is needed.</p></div><div><h3>Design</h3><p>Point prevalence study.</p></div><div><h3>Setting</h3><p>Adult ICUs in Australia and New Zealand.</p></div><div><h3>Participants</h3><p>All adult patients admitted to participating Intensive Care Units (ICUs) on the study day.</p></div><div><h3>Main outcome measures</h3><p>Time awake overnight (22:00–06:00) was determined by structured nurse observation. The use of enterally administered sedative-hypnotic drugs prior to and during ICU admission was recorded, as was the use of a unit policy and non-pharmacological sleep promotion strategies.</p></div><div><h3>Results</h3><p>Data were available for 532 patients admitted to 40 ICUs (median age 60 years, 336 (63.2%) male, and 222 (41.7%) invasively ventilated). Forty-eight patients (9.0%) received an enteral pharmacological sleep aid, of which melatonin (28, 5.2%) was most frequently used. Patients not invasively ventilated were observed to be awake overnight for a median of 4.0 h (interquartile range (IQR): 2.5, 5.5), with no difference in those receiving an enteral hypnotic (p = 0.9). Non-pharmacological sleep aids were reportedly not offered or available for 52% (earplugs) and 63% of patients (eye masks). Only 7 (17.5%) participating ICUs had a policy informing sleep-optimising interventions.</p></div><div><h3>Conclusions</h3><p>Patients not receiving invasive ventilation appeared to spend many nocturnal hours awake. Pharmacological sleep aid administration was not associated with a greater observed time asleep. Most patients did not receive any non-pharmacological aid, and most ICUs did not have a local guideline or unit policy on sleep promotion.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 192-197"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000255/pdfft?md5=57ab8f01891fcbe0c84f074506be7286&pid=1-s2.0-S1441277224000255-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230348","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":"Recommendations for the College of Intensive Care Medicine (CICM) trainee research project: A modified Delphi study","authors":"Ariel Ho MBBS, MPhil ,&nbsp;Kerina J. Denny MBBS, PhD, FCICM ,&nbsp;Kevin B. Laupland MD, PhD, FCICM ,&nbsp;Mahesh Ramanan MBBS, FCICM ,&nbsp;Alexis Tabah MD, FCICM ,&nbsp;James McCullough MBBS, FCICM ,&nbsp;Jessica A. Schults RN, PhD ,&nbsp;Sainath Raman MBBS, FCICM","doi":"10.1016/j.ccrj.2024.05.002","DOIUrl":"10.1016/j.ccrj.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the perceived barriers and enablers to efficient completion of the College of Intensive Care Medicine (CICM) of Australia and New Zealand Formal Project – a trainee research project mandated for award of CICM Fellowship – and to develop consensus-based recommendations to support Intensive Care trainees and supervisors.</p></div><div><h3>Design</h3><p>A two-stage modified Delphi study was conducted. In stage one, an anonymous electronic survey was distributed with three targeted open-ended questions relating to perceived key steps, barriers to, and improvements for efficient completion of the Formal Project. A thematic analysis used the survey results to generate a list of close-ended questions.</p><p>In stage two, a consensus panel comprising of 30 panellists including CICM trainees, Formal Project supervisors and assessors, and critical care researchers, underwent a Delphi process with two rounds of voting and discussion to generate consensus-based recommendations.</p></div><div><h3>Setting</h3><p>Surveys were distributed to Intensive Care Units across Australia and New Zealand. The consensus panel convened at the Queensland Critical Care Research Network Annual Scientific Meeting in Redcliffe, Queensland, Australia, on 9 June 2023.</p></div><div><h3>Participants</h3><p>CICM trainees, Formal Project supervisors and assessors, and critical care researchers in Australia and New Zealand.</p></div><div><h3>Main outcome measures</h3><p>Consensus-based recommendations for the CICM Formal Project.</p></div><div><h3>Results</h3><p>We received 88 responses from the stage one survey. Stage two finalised 22 consensus-based recommendations, centring on key steps of the research process, resources for trainees, and support and training for supervisors.</p></div><div><h3>Conclusions</h3><p>Twenty-two recommendations were developed aiming to make the process of completing the mandatory CICM research project more efficient, and to improve the quality of research produced from these projects.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 169-175"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000140/pdfft?md5=5354597ce9a4a669ec24af9fb32ed068&pid=1-s2.0-S1441277224000140-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230261","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":"Corrigendum to “Statistical analysis plan for the biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2) study: An international randomised controlled multicentre trial” Crit Care Resusc. 26(2) (2024) 80–86. eCollection 2024 Jun","authors":"Thilo von Groote ,&nbsp;Moritz Fabian Danzer ,&nbsp;Melanie Meersch ,&nbsp;Alexander Zarbock ,&nbsp;Joachim Gerß ,&nbsp;BigpAK-2 study group","doi":"10.1016/j.ccrj.2024.09.001","DOIUrl":"10.1016/j.ccrj.2024.09.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 223"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000371/pdfft?md5=8fa51d241a2a1b6d0ee059ef3e516b83&pid=1-s2.0-S1441277224000371-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230549","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":"While you were sleeping","authors":"Neil R. Orford MBBS, FCICM, FANZCA, PGDipEcho, PhD","doi":"10.1016/j.ccrj.2024.06.007","DOIUrl":"10.1016/j.ccrj.2024.06.007","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Page 222"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722400022X/pdfft?md5=7bf9b865c204384263578a2fc2254a82&pid=1-s2.0-S144127722400022X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230450","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}