Critical Care and Resuscitation最新文献

{"title":"Intensive care utilisation after elective surgery in Australia and New Zealand: A point prevalence study","authors":"Philip Emerson MBChB, BSc ,&nbsp;Arthas Flabouris MD, FANZCA, FCICM ,&nbsp;Josephine Thomas B.M., B.S, FRACP, PhD ,&nbsp;Jeremy Fernando MBChB, FANZCA, FCICM ,&nbsp;Siva Senthuran MBBS, FRCA, FCICM, FANZCA ,&nbsp;Serena Knowles BN, PhD ,&nbsp;Naomi Hammond BN, MPH, PhD ,&nbsp;Krish Sundararajan MBBS, MPH, FCICM ,&nbsp;with the George Institute of Global Health","doi":"10.1016/j.ccrj.2023.10.010","DOIUrl":"10.1016/j.ccrj.2023.10.010","url":null,"abstract":"<div><h3>Objective</h3><p>We aimed to describe the characteristics, outcomes and resource utilisation of patients being cared for in an ICU after undergoing elective surgery in Australia and New Zealand (ANZ).</p></div><div><h3>Methods</h3><p>This was a point prevalence study involving 51 adult ICUs in ANZ in June 2021. Patients met inclusion criteria if they were being treated in a participating ICU on he study dates. Patients were categorised according to whether they had undergone elective surgery, admitted directly from theatre or unplanned from the ward. Descriptive and comparative analysis was performed according to the source of ICU admission. Resource utilisation was measured by Length of stay, organ support and occupied bed days.</p></div><div><h3>Results</h3><p>712 patients met inclusion criteria, with 172 (24%) have undergone elective surgery. Of these, 136 (19%) were admitted directly to the ICU and 36 (5.1%) were an unplanned admission from the ward. Elective surgical patients occupied 15.8% of the total ICU patient bed days, of which 44.3% were following unplanned admissions. Elective surgical patients who were an unplanned admission from the ward, compared to those admitted directly from theatre, had a higher severity of illness (AP2 17 vs 13, p&lt;0.01), require respiratory or vasopressor support (75% vs 44%, p&lt;0.01) and hospital mortality (16.7% vs 2.2%, p &lt; 0.01).</p></div><div><h3>Conclusions</h3><p>ICU resource utilisation of patients who have undergone elective surgery is substantial. Those patients admitted directly from theatre have good outcomes and low resource utilisation. Patient admitted unplanned from the ward, although fewer, were sicker, more resource intensive and had significantly worse outcomes.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 1-7"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022214/pdfft?md5=8c3ac9d9a6fc9a882531704c09c851db&pid=1-s2.0-S1441277223022214-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138989654","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":"Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case–control study","authors":"Martin Faltys MD ,&nbsp;Ary Serpa Neto MD ,&nbsp;Luca Cioccari MD","doi":"10.1016/j.ccrj.2023.11.005","DOIUrl":"10.1016/j.ccrj.2023.11.005","url":null,"abstract":"<div><h3>Objective</h3><p>Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear.</p></div><div><h3>Design</h3><p><strong>:</strong> We performed an electronic health record–based quasi-experimental ICU study after cardiac surgery. We applied propensity score matching and compared the physiological changes after FBT episodes to matched control episodes where despite equivalent physiology no fluid bolus was given.</p></div><div><h3>Setting</h3><p>The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital.</p></div><div><h3>Participants</h3><p>The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery.</p></div><div><h3>Main Outcome Measures</h3><p>Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT.</p></div><div><h3>Results</h3><p>We analysed 3572 matched fluid bolus (FB) episodes. After FBT, but not in control episodes, CO increased within 10 min, with a maximum increase of 0.2 l/min (95%CI 0.1 to 0.2) or 4% above baseline at 40 min (p &lt; 0.0001 vs. controls). CO increased by &gt; 10% from baseline in 60.6% of FBT and 49.1% of control episodes (p &lt; 0.0001). MAP increased by &gt; 10% in 51.7% of FB episodes compared to 53.4% of controls. Finally, FBT was not associated with changes in acid-base status or oxygen delivery.</p></div><div><h3>Conclusion</h3><p>In this quasi-experimental comparative ICU study in cardiac surgery patients, FBT was associated with statistically significant but numerically small increases in CO. Nearly half of FBT failed to induce a positive CO or MAP response.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 32-40"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022287/pdfft?md5=c05f831073f20bf5fd98bb007a054e85&pid=1-s2.0-S1441277223022287-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540608","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":"Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial","authors":"Andrew Casamento MBBS, FACEM, FCICM ,&nbsp;Angajendra Ghosh MBBS, FACEM, FCICM ,&nbsp;Victor Hui MBBS, FANZCA ,&nbsp;Ary Serpa Neto PhD, FCICM","doi":"10.1016/j.ccrj.2023.11.004","DOIUrl":"10.1016/j.ccrj.2023.11.004","url":null,"abstract":"<div><h3>Objectives</h3><p>Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.</p></div><div><h3>Design</h3><p>We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.</p></div><div><h3>Setting</h3><p>Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.</p></div><div><h3>Main outcome measures</h3><p>We assessed discharge and long-term (90–365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.</p></div><div><h3>Results</h3><p>We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90–180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180–365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.</p></div><div><h3>Conclusions</h3><p>Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 24-31"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022275/pdfft?md5=8c3027f35904a1be48e6bb74ee086a39&pid=1-s2.0-S1441277223022275-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638790","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 “Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) trial: Study protocol and statistical analysis plan” [Crit Care Resuscit 25 (2023) 118–125]","authors":"Aidan Burrell PhD ,&nbsp;Sze Ng MBBS ,&nbsp;Kelly Ottosen MHealthSc ,&nbsp;Michael Bailey PhD ,&nbsp;Hergen Buscher MD ,&nbsp;John Fraser PhD ,&nbsp;Andrew Udy PhD ,&nbsp;David Gattas MMed(ClinEpi) ,&nbsp;Richard Totaro MBBS ,&nbsp;Rinaldo Bellomo PhD ,&nbsp;Paul Forrest MBChB ,&nbsp;Emma Martin BpharmSc ,&nbsp;Liadain Reid MPH ,&nbsp;Marc Ziegenfuss MBBS ,&nbsp;Glenn Eastwood PhD ,&nbsp;Alisa Higgins PhD ,&nbsp;Carol Hodgson PhD ,&nbsp;Edward Litton PhD ,&nbsp;Priya Nair PhD ,&nbsp;Neil Orford PhD ,&nbsp;David Pilcher MBBS","doi":"10.1016/j.ccrj.2024.01.003","DOIUrl":"10.1016/j.ccrj.2024.01.003","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Page 60"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000036/pdfft?md5=145a3cb312b74a4b65d18bc9bdaa6448&pid=1-s2.0-S1441277224000036-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139818779","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":"Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19","authors":"Ashwin Subramaniam MBBS MMed FRACP FCICM PhD ,&nbsp;Ryan Ruiyang Ling Dr MBBS ,&nbsp;David Pilcher MBBS MRCP(UK) FRACP FCICM","doi":"10.1016/j.ccrj.2023.11.001","DOIUrl":"10.1016/j.ccrj.2023.11.001","url":null,"abstract":"<div><h3><strong>Objective</strong></h3><p>Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19.</p></div><div><h3><strong>Design, Setting and Participants</strong></h3><p>This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as ‘not frail’ (CFS 1-3), ‘mildly frail’ (CFS 4-5) and ‘moderately-to-severely frail’ (CFS 6-8).</p></div><div><h3>Main Outcome Measures</h3><p>The primary outcome was survival time up to two years, which we analysed using Cox regression models.</p></div><div><h3>Results</h3><p>We included 4028 patients with COVID-19 in the final analysis. ‘Moderately-to-severely frail’ patients were older (66.6 [56.3–75.8] vs. 69.9 [60.3–78.1]; p &lt; 0.001) than those without frailty (median [interquartile range] 53.0 [40.1–64.6]), had higher sequential organ failure assessment scores (p &lt; 0.001), and less likely to receive mechanical ventilation (p &lt; 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75–3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89–3.42) had higher mortality rates than those without frailty.</p></div><div><h3>Conclusions</h3><p>Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.</p></div><div><h3>Clinical trial registration</h3><p>Not applicable.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 16-23"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S144127722302224X/pdfft?md5=623a0c26eafbdc32cf648670cb8341a7&pid=1-s2.0-S144127722302224X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014728","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":"Regional access to a centralized extracorporeal membrane oxygenation (ECMO) service in Victoria, Australia","authors":"Joanna WY. Chow MBBS ,&nbsp;John F. Dyett MBBS ,&nbsp;Steve Hirth MIT ,&nbsp;Julia Hart MD ,&nbsp;Graeme J. Duke MBBS, MD","doi":"10.1016/j.ccrj.2023.11.007","DOIUrl":"10.1016/j.ccrj.2023.11.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Victoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described.</p></div><div><h3>Objective</h3><p>Describe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access.</p></div><div><h3>Design</h3><p>Retrospective observational study with spatial mapping.</p></div><div><h3>Participants and setting</h3><p>Adult (≥18 years) ECMO recipients from July 2016–June 2022. Data from administrative Victorian Admissions Episodes Database analysed in conjunction with Australian Urban Research Infrastructure Network population data and choropleth mapping. Presumed ECMO modes were inferred from cardiopulmonary bypass and pre-hospital cardiac arrest codes. Spatial autoregressive models including Moran's test used for spatial lag testing.</p></div><div><h3>Outcomes</h3><p>Demographics and outcomes of ECMO recipients; ECMO incidence by patient residence (Statistical-Area Level 2, SA-2) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD); and ECMO utilisation adjusted for patient factors and linear distance from the central ECMO referral site.</p></div><div><h3>Results</h3><p>631 adults received ECMO over 6 years, after exclusion of paediatric (n = 242), duplicate (n = 135), and interstate or incomplete (n = 72) records. Mean age was 51.8 years, and 68.8 % were male. Overall ECMO incidence was 3.00 ± 3.95 per 10⁵ population. 135 (21.4 %) were presumed VA-ECMO, 59 (9.3 %) presumed ECPR, and 437 (69.3 %) presumed VV-ECMO. Spatial lag was non-significant after adjusting for patient characteristics. Distance from the central referral site (dy/dx = 0.19, 95% CI −0.41–0.04, p = 0.105) and IRSAD score (dy/dx = 0.17, 95% CI −0.19–0.53, p = 0.359) did not predict ECMO utilisation.</p></div><div><h3>Conclusion</h3><p>Victorian ECMO incidence rates were low. We did not find evidence of inequity of access to ECMO irrespective of regional area or socioeconomic status.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 47-53"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022305/pdfft?md5=874c0a47498fe407518adfd01eb39f56&pid=1-s2.0-S1441277223022305-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017810","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":"An intensivist-led ECMO accreditation pathway and safety data over the first 4 years","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.2023.11.006","DOIUrl":"10.1016/j.ccrj.2023.11.006","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the training and accreditation process behind an intensivist-led extracorporeal membrane oxygenation (ECMO) cannulation program, and identify the rate of complications associated with the ECMO cannulation procedure.</p></div><div><h3>Design</h3><p>A narrative review of the accreditation process, and a retrospective review of complications related to cannulation during the first four years of the intensivist program.</p></div><div><h3>Setting</h3><p>Royal Prince Alfred Hospital, a quaternary referral hospital in Sydney.</p></div><div><h3>Participants</h3><p>All patients initiated onto ECMO during the first four years of the intensivist cannulation program (August 2018 to August 2022).</p><p>Main outcome measures: All cases were reviewed for identification of 14 pre-defined adverse events which were classified as low, medium or high clinical significance complications.</p></div><div><h3>Results</h3><p>A total of 402 cannulations were attempted by the intensivist group in 194 separate cannulation episodes involving 179 patients. This included 93 V–V initiations, 69 V-A initiations (36 of these ECMO-CPR), 3 V-AV (veno-arteriovenous) initiations, 25 ECMO reconfigurations and four patients cannulated for peripheral cardiopulmonary bypass in cardiothoracic theatre. One of the 402 cannulations was halted as resuscitation was ceased, and one was halted and the patient transferred to theatre for central arterial cannulation. 394 out of the remaining 400 cannulations were successful (98.5%). Of 402 total cannulations, 32 complication events occurred (7.96% event rate), of which 15 (3.7% event rate) were low significance complications, 10 medium significance (2.5% event rate), and seven high clinical significance (1.7% event rate).</p></div><div><h3>Conclusions</h3><p>Our experience of the first four years of an intensivist-led ECMO service demonstrates that our training process and cannulation technique result in the provision of a complex therapy with low levels of complications, on par with those in the published literature.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 1","pages":"Pages 41-46"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022299/pdfft?md5=9c4c5445c9260ca547003e4f7a54ce7b&pid=1-s2.0-S1441277223022299-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019948","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 pressure reactivity index as a measure of cerebral autoregulation and its application in traumatic brain injury management","authors":"Zac A. Tsigaras MD ,&nbsp;Mark Weeden MBBS ,&nbsp;Robert McNamara BMBS ,&nbsp;Toby Jeffcote PhD ,&nbsp;Andrew A. Udy PhD","doi":"10.1016/j.ccrj.2023.10.009","DOIUrl":"10.1016/j.ccrj.2023.10.009","url":null,"abstract":"<div><p>Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality globally. The Brain Trauma Foundation guidelines advocate for the maintenance of a cerebral perfusion pressure (CPP) between 60 and 70 mmHg following severe TBI. However, such a uniform goal does not account for changes in cerebral autoregulation (CA). CA refers to the complex homeostatic mechanisms by which cerebral blood flow is maintained, despite variations in mean arterial pressure and intracranial pressure. Disruption to CA has become increasingly recognised as a key mediator of secondary brain injury following severe TBI. The pressure reactivity index is calculated as the degree of statistical correlation between the slow wave components of mean arterial pressure and intracranial pressure signals and is a validated dynamic marker of CA status following brain injury. The widespread acceptance of pressure reactivity index has precipitated the consideration of individualised CPP targets or an optimal cerebral perfusion pressure (CPPopt). CPPopt represents an alternative target for cerebral haemodynamic optimisation following severe TBI, and early observational data suggest improved neurological outcomes in patients whose CPP is more proximate to CPPopt. The recent publication of a prospective randomised feasibility study of CPPopt guided therapy in TBI, suggests clinicians caring for such patients should be increasingly familiar with these concepts. In this paper, we present a narrative review of the key landmarks in the development of CPPopt and offer a summary of the evidence for CPPopt-based therapy in comparison to current standards of care.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 229-236"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022202/pdfft?md5=3aaa9706cf83c230ad90f982dca035d4&pid=1-s2.0-S1441277223022202-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139026239","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":"Masking of an intravenous preparation of ceftriaxone for use in clinical trials: A technical report","authors":"David M. Golding MBBCh, BSc, PGDip ,&nbsp;Tak Wai Chan BMedSci, BMBS ,&nbsp;Nikola G. Orozov MPharm, PGDipClinPharm ,&nbsp;Paul J. Young MBChB, PhD","doi":"10.1016/j.ccrj.2023.10.002","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.002","url":null,"abstract":"<div><h3>Background</h3><p>Intravenous antibiotics are often evaluated in clinical trials in hospitalised patients but for blinded trials masking of antibiotics is required.</p></div><div><h3>Objective</h3><p>To evaluate the effectiveness of masking of ceftriaxone and amoxicillin / clavulanic acid for use in blinded clinical trials.</p></div><div><h3>Design, setting, and participants</h3><p>Amoxicillin / clavulanic acid (1.2g) and ceftriaxone (1g and 2g) were diluted in 100mL of sodium chloride. Clinicians from a single centre were asked to attempt to distinguish solutions containing antibiotics from solutions without added antibiotics at time points up to 12 hours following dilution.</p></div><div><h3>Results</h3><p>1g of ceftriaxone diluted in 100 mL of 0.9 sodium chloride stored in a light-protected bag and refrigerated at 3–4 °C for up to 10 h could not readily be distinguished from 100 mL of 0.9 % sodium chloride. However, solutions containing either amoxicillin / clavulanic acid (1.2g) or ceftriaxone (2g) were readily identifiable.</p></div><div><h3>Conclusions</h3><p>1 g of ceftriaxone can be effectively masked by dilution in 100mL of sodium chloride.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 172-174"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005197/pdfft?md5=e7dacd1406f9e34280d35ca19a0c7474&pid=1-s2.0-S1441277223005197-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038538","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":"Perceptions of intensive care triage in Australia and New Zealand in 2009 and 2023","authors":"William B. Blackburne MBChB, BMedSc(Hons),&nbsp;Paul J. Young MBChB, PhD, FCICM","doi":"10.1016/j.ccrj.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>Intensive care (ICU) beds are scarce and decision-making regarding admission is complex and multi-factorial. This study aimed to characterise differences in admission decision making between Australia and New Zealand and compare to previous data to establish changes over time.</p></div><div><h3>Design</h3><p>Online Survey.</p></div><div><h3>Setting and Participants</h3><p>An online survey was distributed to Australian and New Zealand intensive care doctors measuring triage behaviours in the last week and responses to ICU triage scenarios.</p></div><div><h3>Main Outcome Measures</h3><p>Perceived ICU admission behaviours.</p></div><div><h3>Results</h3><p>103 responses were obtained, 83(80.6%) from Australia and 97 (94.2%) from specialist intensivists. The median number of triage decisions and patients declined were 6-10 and 1-5 respectively. No difference was noted in the role of ICU bed capacity in decision making between Australia and New Zealand. Compared to Australian intensivists, New Zealand intensivists were less likely to admit a patient: with relapsed acute myeloid leukaemia (AML) and acute respiratory distress syndrome (ARDS)(p=0.03), with persistent vegetative state and community acquired (p=0.02) or iatrogenic (p=0.03) pneumonia. Compared to respondents in 2009 (n=238), 2023 respondents were more likely to admit a patient: with a severe intracranial bleed who may become braindead (p=0.005), with relapsed AML and ARDS (p=0.02), with stroke for palliative care (p&lt;0.001); and less likely to admit a patient with persistent vegetative state and iatrogenic pneumonia (p=0.03). In a multivariable analysis, respondents from Australian compared to New Zealand and from 2023 compared to 2009 were more likely to indicate they would admit patients to the ICU in the scenarios described (p&lt;0.001 for both comparisons).</p></div><div><h3>Conclusions</h3><p>Our study suggests that New Zealand intensivists may apply more restrictive ICU admission criteria than Australian intensivists. Changes in attitudes to admission since 2009 may reflect increased awareness of the importance of facilitating organ donation and the role of ICU as providers of palliative care.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 161-171"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005173/pdfft?md5=fdcf748f336da0e420536690d82dd950&pid=1-s2.0-S1441277223005173-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038539","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}