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 , 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","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}
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 , Kuan-Ying Lu MBiomedEng , Philip Lewis PhD , Dashiell Gantner FCICM, PhD , Camila R. Battistuzzo PhD , 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}
{"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}
{"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 , Dharshi Karalapillai MBBS, PhD, FANZCA, FCICM, PGDipUS , Helen Kolawole BMedSc, MBBS, MClinEd, FANZCA , Chris Fiddes MBBS, FANZCA , David Pilcher MBBS, MRCP, FRACP, FCICM , 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}
Michael Kouch M.D, Nitin Puri M.D, Emily Damuth M.D, Christopher Noel M.D, Jason Bartock M.D, Adam Green M.D
{"title":"More than one pathway: ECMO training and credentialing","authors":"Michael Kouch M.D, Nitin Puri M.D, Emily Damuth M.D, Christopher Noel M.D, Jason Bartock M.D, 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}
Kyle C. White FCICM, MPH , James McCullough FCICM, MMed , Kiran Shekar FCICM, PhD , Siva Senthuran FCICM, MBBS , Kevin B. Laupland FCICM, PhD , Goce Dimeski BSc Med Lab, PhD , Ary Serpa-Neto FCICM, PhD , Rinaldo Bellomo MD, PhD , Queensland Critical Care Research Network (QCRCN)
{"title":"Point-of-care creatinine vs. central laboratory creatinine in the critically ill","authors":"Kyle C. White FCICM, MPH , James McCullough FCICM, MMed , Kiran Shekar FCICM, PhD , Siva Senthuran FCICM, MBBS , Kevin B. Laupland FCICM, PhD , Goce Dimeski BSc Med Lab, PhD , Ary Serpa-Neto FCICM, PhD , Rinaldo Bellomo MD, PhD , 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}
Halvor Ø. Guldbrandsen MD , Peter Juhl-Olsen MD, PhD , Glenn M. Eastwood MD, PhD , Kasper L. Wethelund BMSc , Anders M. Grejs MD, PhD
{"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 , Peter Juhl-Olsen MD, PhD , Glenn M. Eastwood MD, PhD , Kasper L. Wethelund BMSc , 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 (PaCO<sub>2</sub> 50–55 mmHg) or targeted normocapnia (PaCO<sub>2</sub> 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}
Laurie Showler MBChB , Adam M. Deane MBBS PhD , Edward Litton MBChB MSc , Melissa J. Ankravs BPharm MClinPharm , Bradley Wibrow MBBS MSc , Deborah Barge RN RM CCRN , Jeremy Goldin MBBS MM , Naomi Hammond RN MN PhD , Manoj K. Saxena MMBChir BSc , Paul J. Young MBChB PhD , Bala Venkatesh MBBS MD , Mark Finnis MBBS MBiostat , Yasmine Ali Abdelhamid MBBS PhD
{"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 , Adam M. Deane MBBS PhD , Edward Litton MBChB MSc , Melissa J. Ankravs BPharm MClinPharm , Bradley Wibrow MBBS MSc , Deborah Barge RN RM CCRN , Jeremy Goldin MBBS MM , Naomi Hammond RN MN PhD , Manoj K. Saxena MMBChir BSc , Paul J. Young MBChB PhD , Bala Venkatesh MBBS MD , Mark Finnis MBBS MBiostat , 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}