Critical Care and Resuscitation最新文献

{"title":"Outcomes for Pacific and European patients admitted to New Zealand intensive care units from 2009 to 2018","authors":"Paul J. Young BSc (Hons), MBChB, PhD ,&nbsp;Michael Bailey PhD ,&nbsp;the ANZICS CORE Management Committee","doi":"10.1016/j.ccrj.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the characteristics and outcomes of Pacific and European patients admitted to New Zealand (NZ) intensive care units (ICUs) 2009–2018.</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting and participants</h3><p>The NZ Ministry of Health National Minimum Dataset and the Australia NZ Intensive Care Society Adult Patient Database were matched. Data were for ICU admissions in NZ hospitals from July 2009 until June 2018; long-term mortality outcomes were obtained from the NZ death registry until June 2020.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome was day 180 mortality. Secondary outcomes were ICU mortality, hospital mortality, discharge to home, ICU and hospital length of stay, and survival. We evaluated the associations between Pacific ethnicity and outcomes with European as the reference using regression analyses. We adjusted sequentially for site, deprivation status, sex, year of admission, Charlson Comorbidity Index, age, admission source and type, ICU admission diagnosis, ventilation status, and illness severity.</p></div><div><h3>Results</h3><p>Pacific people had a median age of 14 years younger than Europeans. 644/4603 (14.0%) Pacific, and 6407/42,871 (14.9%) European patients died within 180 days of ICU admission; odds ratio (OR) 0.93; 95% CI, 0.85–1.01. When adjusting for age, the OR for day 180 mortality for Pacific vs. European patients increased. The OR decreased after adjustment for admission source and type, and after accounting for Pacific patients having a higher comorbidity index and more severe illness. In the final model, incorporating adjustments for all specified variables, Pacific ethnicity was not significantly associated with day 180 mortality (adjusted OR 0.91; 95% CI, 0.80–1.05). Findings were similar for secondary outcomes except for the proportion of patients discharged home; Pacific ethnicity was associated with significantly increased odds of being discharged home compared to European ethnicity.</p></div><div><h3>Conclusions</h3><p>Pacific ethnicity was not associated with increased day 180 mortality compared to European ethnicity; Pacific patients admitted to the ICU were more likely to be discharged home than European patients.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 100-107"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000115/pdfft?md5=880b7a9f126f0c2ff2413131fdc633b9&pid=1-s2.0-S1441277224000115-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486189","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":"Bias, trending ability and diagnostic performance of a non-calibrated multi-beat analysis continuous cardiac output monitor to identify fluid responsiveness in critically ill patients","authors":"Laurent Bitker MD, PhD ,&nbsp;Inès Noirot MD ,&nbsp;Louis Chauvelot MD ,&nbsp;Mehdi Mezidi MD, MSc ,&nbsp;François Dhelft MD, MSc ,&nbsp;Maxime Gaillet MD ,&nbsp;Hodane Yonis MD ,&nbsp;Guillaume Deniel MD, MSc ,&nbsp;Jean-Christophe Richard MD, PhD","doi":"10.1016/j.ccrj.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.04.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO_MBA), against calibrated pulse-contour analysis continuous cardiac output (CCO_PCA) during a passive leg raise (PLR) and/or a fluid challenge (FC).</p></div><div><h3>Design</h3><p>Observational, single-centre, prospective study.</p></div><div><h3>Setting</h3><p>Tertiary academic medical intensive care unit, Lyon, France.</p></div><div><h3>Participants</h3><p>Adult patients receiving norepinephrine, monitored by CCO_PCA, and in which a PLR and/or a FC was indicated.</p></div><div><h3>Main outcome measures</h3><p>CCO_MBA and CCO_PCA were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO_MBA and CCO_PCA (∆%CCO_MBA and ∆%CCO_PCA). Fluid responsiveness was identified by an increase &gt;15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO_MBA threshold during PLR to predict fluid responsiveness.</p></div><div><h3>Results</h3><p>29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO_PCA values, with a percentage error of 64% (_95%confidence interval: 52%–77%). ∆%CCO_MBA adequately tracked changes in ∆%CCO_PCA with an angular bias of 2 ± 29°. ∆%CCO_MBA during PLR had an AUROC of 0.92 (<em>P</em> &lt; 0.05), with an optimal threshold &gt;14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).</p></div><div><h3>Conclusions</h3><p>CCO_MBA showed a non-constant bias and a percentage error &gt;30% against calibrated CCO_PCA, but an adequate ability to track changes in CCO_PCA and to predict fluid responsiveness.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 108-115"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000127/pdfft?md5=b5598a5c4abd944b51bf2371a07c3fa7&pid=1-s2.0-S1441277224000127-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486190","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 impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia","authors":"Paul Ross RN, BHSc Nur, PGCert ICU, MN Research, Med Adult, PhD Candidate ,&nbsp;Rose Jaspers RN, BN(Hons), MAdvClinNur ,&nbsp;Jason Watterson RN, BHSc Nur, PGDipAdvNur CritCare, Med Adult, PhD ,&nbsp;Michelle Topple RN, BHSc Nur, PGDipSci, PGCert ICU ,&nbsp;Tania Birthisel RN, BN (Distinction), PGDip Nursing ICU, CertIV TAE, MProfEd&Trng ,&nbsp;Melissa Rosenow ,&nbsp;Jason McClure MB ChB, MRCP, FRCA, FCICM, Dip Engineering ,&nbsp;Ged Williams AO, RN, PGCert ICU, BHSc. Adv. Nursing, LLM, MHA, FACN, FACHSM, FAAN ,&nbsp;Wendy Pollock RN, RM, Grad Cert Adv Learning & Leadership, Grad Dip Ed, Grad Dip Crit Car Nsg, PhD ,&nbsp;David Pilcher MBBS MRCP(UK) FCICM FRACP","doi":"10.1016/j.ccrj.2024.03.002","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.03.002","url":null,"abstract":"<div><h3>Objective</h3><p>This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient's stay.</p></div><div><h3>Design</h3><p>Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.</p></div><div><h3>Settings</h3><p>Fifteen public and 5 private hospital ICUs in Victoria, Australia.</p></div><div><h3>Participants</h3><p>There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.</p></div><div><h3>Main outcome measures</h3><p>Primary outcome: in-hospital mortality. Secondary outcomes: in-ICU mortality, development of delirium, pressure injury, duration of stay in-ICU and hospital, after-hours discharge from ICU and readmission to ICU.</p></div><div><h3>Results</h3><p>In total, 6563 (39.5%) patients were cared for in ICUs with &gt;75% CCRN, 7695 (46.3%) in ICUs with 50–75% CCRN, and 2360 (14.2%) in ICUs with &lt;50% CCRN. In-hospital mortality was 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%) respectively. After adjusting for confounders, patients cared for in ICUs with 50–75% CCRN (adjusted OR 1.21 [95% CI 1.02–1.45]) were more likely to die compared to patients in ICUs with &gt;75% CCRN. A similar but non-significant trend was seen in ICUs with &lt;50% CCRN (adjusted OR 1.21 [95% CI 0.94–1.55]), when compared to patients in ICUs with &gt;75% CCRN. In-ICU mortality, delirium, pressure injuries, after-hours discharge and ICU length of stay were lower in ICUs with CCRN&gt;75%.</p></div><div><h3>Conclusion</h3><p>The nursing skill-mix in ICU impacts outcomes and should be routinely monitored. Health system regulators, hospital administrators and ICU leaders should ensure nursing workforce planning and education align with these findings to maximise patient outcomes.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 135-152"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000073/pdfft?md5=ad56c53e3b427ddb83eca17ebc80ad04&pid=1-s2.0-S1441277224000073-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486286","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":"Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process","authors":"Jessica A. Schults RN, PhD ,&nbsp;Karina R. Charles RN, MNurs PICU ,&nbsp;Johnny Millar MBChB, PhD, MRCP, FRACP, FCICM ,&nbsp;Claire M. Rickard RN, PhD ,&nbsp;Vineet Chopra MD, MSc ,&nbsp;Anna Lake RN, GradCertClinNurs ,&nbsp;Kristen Gibbons PhD ,&nbsp;Debbie Long RN, PhD ,&nbsp;Sarfaraz Rahiman MD, FCICM ,&nbsp;Katrina Hutching RN, MHlthLd ,&nbsp;Jacinta Winderlich BNutDietet, MClinRes ,&nbsp;Naomi E. Spotswood BMedSc, MBBS, MIPH, FRACP ,&nbsp;Amy Johansen RN, MANP Research ,&nbsp;Paul Secombe BA, DipAud, BMBS (Hons), MClinSc, FCICM ,&nbsp;Georgina A. Pizimolas BPhty ,&nbsp;Quyen Tu BPharm ,&nbsp;Michaela Waak MBBS, MD ,&nbsp;Meredith Allen MBBS, FRACP, FCICM, PhD, MSafSc ,&nbsp;Brendan McMullan BMed (Hons), PhD ,&nbsp;Lisa Hall BTech BiomedSci (Hons), PhD","doi":"10.1016/j.ccrj.2024.01.002","DOIUrl":"10.1016/j.ccrj.2024.01.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.</p></div><div><h3>Objective</h3><p>We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.</p></div><div><h3>Design</h3><p>We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care.</p></div><div><h3>Setting and participants</h3><p>Australian and New Zealand paediatric critical care survivors (aged &gt;18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main outcome measures</h3><p>Priorities for quality measures.</p></div><div><h3>Results</h3><p>Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated.</p></div><div><h3>Conclusion(s)</h3><p>We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 71-79"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000024/pdfft?md5=1c8a257336d16ba76cf05b0274d701de&pid=1-s2.0-S1441277224000024-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407310","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":"Costs of Australian intensive care: A systematic review","authors":"Alayna Carrandi MPH ,&nbsp;Cheelim Liew DNP ,&nbsp;Matthew J. Maiden PhD ,&nbsp;Edward Litton PhD ,&nbsp;Colman Taylor PhD ,&nbsp;Kelly Thompson PhD ,&nbsp;Alisa Higgins PhD","doi":"10.1016/j.ccrj.2024.03.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia.</p></div><div><h3>Design</h3><p>A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded.</p></div><div><h3>Data sources</h3><p>Relevant studies were sourced from a previously published review (1970–2016), a systematic search of MEDLINE and EMBASE (2016–5 May 2023), and reference checking.</p></div><div><h3>Review methods</h3><p>A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised.</p></div><div><h3>Results</h3><p>Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use.</p></div><div><h3>Conclusions</h3><p>Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 153-158"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000085/pdfft?md5=c935f67b062c4593cc05e60fc4ca039c&pid=1-s2.0-S1441277224000085-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486193","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":"Health concerns of intensive care survivors and research participation willingness: A multicentre survey","authors":"Reyas Aboobacker Kaniyamparambil MBBS FCICM ,&nbsp;Charlotte Goldsmith MBBS ,&nbsp;Nicolas Demasi MBBS ,&nbsp;Brad Wibrow MBBS FCICM ,&nbsp;Prakkash ParangiAnanthan MBBS FCICM ,&nbsp;Adrian Regli MBBS PhD ,&nbsp;Matt Anstey MBBS FCICM ,&nbsp;Susan Pellicano RN ,&nbsp;Anne Marie Palermo RN ,&nbsp;Sarah Van Der Laan MBBS ,&nbsp;Edward Litton MBBS PhD","doi":"10.1016/j.ccrj.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the relative importance of health concerns reported by survivors of critical illness treated in the intensive care unit (ICU), their estimate of time to achieve recovery, and their reported randomised clinical trial participation willingness.</p></div><div><h3>Design</h3><p>A multicentre survey.</p></div><div><h3>Setting</h3><p>Six Australian ICUs.</p></div><div><h3>Participants</h3><p>Adult patients who had received mechanical ventilation, vasopressor support or renal replacement therapy for more than 24 h were likely to be discharged from ICU within 24 h.</p></div><div><h3>Interventions</h3><p>Survey administration was verbal and occurred in the ICU.</p></div><div><h3>Main outcome measures</h3><p>A numeric rating of eight ICU survivor-related health concerns developed with consumer input (disability requiring ongoing care, prolonged hospitalisation, repeated hospitalisation, impaired activity level, pain, low mood, inability to return home, and dying). Zero indicated no concern and ten extreme concern. Respondents were also asked to estimate their expected recovery time and their willingness to participate in a randomised clinical trial.</p></div><div><h3>Results</h3><p>Of 584 eligible participants, 286 (49.0%) respondents had a mean age of 62.3 years (standard deviation (SD) 14.8) and 178 (62.2%) were male. The median ICU length of stay at the time of survey was 4 days (interquartile range (IQR) 3–7). Respondents reported high levels of concern for all health outcomes with the highest median scores being for survival with severe disability and requirement for ongoing care scoring 8 (IQR 3–10), and never being able to return home needing assisted living or a nursing home scoring 8 (IQR 1–10). The median expected recovery time was 23 days (IQR 10–33). Higher concerns were associated with an increased likelihood of trial participation willingness.</p></div><div><h3>Conclusion</h3><p>Survivors reported high and varied health concerns of which severe disability requiring care and inability to return home were the highest. Respondents anticipated a relatively short recovery.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 95-99"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000103/pdfft?md5=cee43030dd7e195fb4d9ed4e617f67c7&pid=1-s2.0-S1441277224000103-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486192","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 and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults in the intensive care unit with suspected hypoxic ischaemic encephalopathy following a cardiac arrest (Mega-ROX HIE)","authors":"Paul J. Young MBChB, FCICM, 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;Mohd Shahnaz Hasan MBBS, MAnes ,&nbsp;Carol L. Hodgson PT, MPhil, PhD ,&nbsp;Anna Hunt BN ,&nbsp;Cassie Lawrence BN ,&nbsp;Israel Silva Maia ,&nbsp;Diane Mackle MN, PhD ,&nbsp;Giacomo Monti MD ,&nbsp;Alistair D. Nichol PhD ,&nbsp;Jessica Kasza PhD","doi":"10.1016/j.ccrj.2024.03.004","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.03.004","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 hypoxic ischaemic encephalopathy (HIE) following a cardiac arrest who are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.</p></div><div><h3>Objective</h3><p>To summarise the protocol and statistical analysis plan for the Mega-ROX HIE trial.</p></div><div><h3>Design, setting and participants</h3><p>Mega-ROX HIE is an international randomised clinical trial that will be conducted within an overarching 40,000-participant registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol approximately 4000 participants with suspected HIE following a cardiac arrest who are receiving invasive mechanical ventilation in the ICU.</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 participants discharged home.</p></div><div><h3>Results and conclusions</h3><p>Mega-ROX HIE will compare the effect of conservative vs. liberal oxygen therapy regimens on day-90 in-hospital mortality in adults in the ICU with suspected HIE following a cardiac arrest. The protocol and planned analyses are reported here to mitigate analysis bias.</p></div><div><h3>Trial registration</h3><p>Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 2","pages":"Pages 87-94"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000097/pdfft?md5=bd9cfd07b4ef9f23c523fcf07f5af277&pid=1-s2.0-S1441277224000097-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486285","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":"Continuous glucose monitor accuracy during extracorporeal membrane oxygenation","authors":"Tipwarin Phongmekhin BS (Bachelor of Science) ,&nbsp;Ray Wang MBBS BMedSci FRACP","doi":"10.1016/j.ccrj.2023.11.003","DOIUrl":"10.1016/j.ccrj.2023.11.003","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 58-59"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022263/pdfft?md5=93c014843713d5c9af5db9b3f8c832e8&pid=1-s2.0-S1441277223022263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138988602","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":"Services for critical and emergency care of children in Victoria","authors":"Trevor Duke MD, FRACP, FCICM","doi":"10.1016/j.ccrj.2023.11.008","DOIUrl":"10.1016/j.ccrj.2023.11.008","url":null,"abstract":"<div><p>The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system.</p><p>The effects of changes in disease patterns, social trends and health practice should inform the design of an expanded model of critical and emergency care for children in Victoria that is more fit for purpose in the remainder of this decade and beyond.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 54-57"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022317/pdfft?md5=1775d1b02619a27698339e8895ef43f1&pid=1-s2.0-S1441277223022317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021710","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":"Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study","authors":"Sumeet Rai FCICM ,&nbsp;Teresa Neeman PhD ,&nbsp;Rhonda Brown PhD ,&nbsp;Krishnaswamy Sundararajan FCICM ,&nbsp;Arvind Rajamani FCICM ,&nbsp;Michelle Miu B.Med, MD ,&nbsp;Rakshit Panwar PhD ,&nbsp;Mary Nourse GradCertIntCareN ,&nbsp;Frank M.P. van Haren PhD ,&nbsp;Imogen Mitchell PhD ,&nbsp;Dale M. Needham MD, PhD ,&nbsp;for the PRICE study investigators","doi":"10.1016/j.ccrj.2023.10.011","DOIUrl":"10.1016/j.ccrj.2023.10.011","url":null,"abstract":"<div><h3>Objective</h3><p>To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors.</p></div><div><h3>Design</h3><p>Prospective, multicentre observational cohort study.</p></div><div><h3>Setting</h3><p>Four tertiary medical-surgical ICUs in Australia.</p></div><div><h3>Participants</h3><p>Intubated and non-intubated adult ICU survivors.</p></div><div><h3>Main outcome measures</h3><p><em>Primary outcomes</em>: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. <em>Secondary outcomes</em>: HRQOL, using EuroQol-5D-5L questionnaire.</p></div><div><h3>Results</h3><p>Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66–3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53–3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with &gt;30 % at 3 versus months and &gt;20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions.</p></div><div><h3>Conclusions</h3><p>Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 8-15"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022226/pdfft?md5=a492e68faadb17e270bc1dfc1805a955&pid=1-s2.0-S1441277223022226-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023796","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}