Critical Care and Resuscitation最新文献

{"title":"Pfizer BNT 162b2 COVID-19 vaccine–induced fulminant myopericarditis: A case study","authors":"Natalie L. Montarello Cardiologist, MBBS, FRACP ,&nbsp;Hao Zheng Wong Intensivist, MBBS, FCICM ,&nbsp;Ashlee Jeffries Cardiology Registrar, MBBS ,&nbsp;Griffith B. Perkins Researcher in Immunology, BSc(Adv), PhD ,&nbsp;Pravin Hissaria Immunologist, MBBS, MD, DM, FRACP, FRCPA ,&nbsp;Michael B. Stokes Cardiologist, MBBS, FRACP ,&nbsp;Eamon Raith Intensivist, MBBS, MACCP, PhD ,&nbsp;Karen Teo Cardiologist, MBBS, FRACP, PhD ,&nbsp;Julie Bradley Cardiologist, MBBS FRACP, FCSANZ","doi":"10.1016/j.ccrj.2023.06.005","DOIUrl":"10.1016/j.ccrj.2023.06.005","url":null,"abstract":"<div><p>The use of mRNA COVID-19 vaccine can on rare occasions cause life-threatening, fulminant myopericarditis. This case report demonstrates previously reported benefit of early use of venoarterial extracorporeal membrane oxygenation mechanical assistance and supports the use of intravenous highly purified immunoglobulin pharmacotherapy to help achieve a good clinical outcome.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 3","pages":"Pages 155-157"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49004639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update in statistical analysis plan of the RENOVATE trial","authors":"I.S. Maia M.D. MSc,&nbsp;L. Kawano-Dourado M.D. Ph.D,&nbsp;L.P. Damiani Ph.D Statistics,&nbsp;M. Fitzgerald M.S. Ph.D Statistics,&nbsp;R.J. Lewis M.D. Ph.D,&nbsp;A.B. Cavalcanti M.D. Ph.D","doi":"10.1016/j.ccrj.2023.06.008","DOIUrl":"10.1016/j.ccrj.2023.06.008","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 3","pages":"Pages 113-114"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47964986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further insights into the longer-term outcomes of patients experiencing in-hospital cardiac arrest","authors":"Gemma M. Pound PT, PhD Candidate,&nbsp;Carol L. Hodgson PT, PhD,&nbsp;Glenn M. Eastwood RN, PhD,&nbsp;Daryl A. Jones MD, PhD","doi":"10.1016/j.ccrj.2023.06.003","DOIUrl":"10.1016/j.ccrj.2023.06.003","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 3","pages":"Page 115"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46547100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls","authors":"Sanith S. Cheriyan MBBS, MSurg ,&nbsp;Mistyka S. Schar BSpPath, PhD ,&nbsp;Charmaine M. Woods B. Biotech (hons), PhD ,&nbsp;Shailesh Bihari FCICM, PhD ,&nbsp;Charles Cock FRACP, PhD ,&nbsp;Theodore Athanasiadis FRACS, PhD ,&nbsp;Taher I. Omari BSC (hons), PhD ,&nbsp;Eng H. Ooi FRACS, PhD","doi":"10.1016/j.ccrj.2023.05.007","DOIUrl":"10.1016/j.ccrj.2023.05.007","url":null,"abstract":"<div><h3>Objective</h3><p>The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.</p></div><div><h3>Design</h3><p>Cohort study.</p></div><div><h3>Setting</h3><p>Australian tertiary hospital intensive care unit.</p></div><div><h3>Participants</h3><p>Tracheostomised adults, planned for decannulation.</p></div><div><h3>Main outcome measures</h3><p>Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.</p></div><div><h3>Results</h3><p>In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (<em>p</em> &lt; 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] <em>v</em> tracheostomy 13.7 mmHg [10.4, 16.9], <em>P</em> &lt; 0.001; control −4.28 mmHg [-5.87, 2.69] <em>v</em> tracheostomy 12.2 mmHg [8.83, 15.6], <em>P</em> &lt; 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], <em>P</em> &lt; 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] <em>v</em> tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; <em>P</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 97-105"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43674566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs","authors":"Matthew H. Anstey MBBS, FCICM, FACEM, MPH, AFRACMA ,&nbsp;Louise Trent MBChB, FCICM, FANZCA, AFRACMA ,&nbsp;Deepak Bhonagiri MBBS, MD, FCICM ,&nbsp;Naomi E. Hammond RN, PhD ,&nbsp;Serena Knowles RN, PhD ,&nbsp;Forbes McGain FCICM FANZCA ,&nbsp;On behalf of The George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.ccrj.2023.05.004","DOIUrl":"10.1016/j.ccrj.2023.05.004","url":null,"abstract":"<div><h3>Objective</h3><p>During the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs.</p></div><div><h3>Design</h3><p>This is a prospective cross-sectional point prevalence study, as part of the 2021 ANZICS Point Prevalence Program. Specific questions related to waste and sustainability practices were asked at the site and patient level.</p></div><div><h3>Setting and participants</h3><p>ANZ adult ICUs and their patients on the day of the study.</p></div><div><h3>Main outcome measures</h3><p>Amount of single use items disposed of per shift, as well as the engagement of the site with sustainability and recycling practices.</p></div><div><h3>Results</h3><p>In total, 712 patients (median number of patients per ICU = 17, IQR 11–30) from 51 ICUs across ANZ were included in our study; 55% of hospitals had a sustainability officer, and recycling paper (86%) and plastics (65%) were frequent, but metal recycling was limited (27%). Per patient bed space per 12-h shift there was recycling of less than 40% paper, glass, intravenous fluid bags, medication cups and metal instruments. A median of 10 gowns (IQR 3–19.5), 10 syringes (4.5–18) and gloves 30 (18–49) were disposed of per bed space, per 12-h shift. These numbers increased significantly when comparing patients with and without infection control precautions in place.</p></div><div><h3>Conclusions</h3><p>In ANZ ICUs, we found utilisation of common ICU consumables to be high and associated with low recycling rates. Interventions to abate resource utilisation and augment recycling are required to improve environmental sustainability in intensive care units.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 78-83"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43442547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential role for extracorporeal membrane oxygenation cardiopulmonary resuscitation (E-CPR) during in-hospital cardiac arrest in Australia: A nested cohort study","authors":"G. Pound PT PhD Candidate ,&nbsp;G.M. Eastwood RN PhD ,&nbsp;D. Jones MD PhD ,&nbsp;C.L. Hodgson PT PhD","doi":"10.1016/j.ccrj.2023.05.006","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.05.006","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to evaluate the characteristics and outcomes of patients who fulfilled extracorporeal membrane oxygenation cardiopulmonary resuscitation (E-CPR) selection criteria during in-hospital cardiac arrest (IHCA).</p></div><div><h3>Design</h3><p>This is a nested cohort study.</p></div><div><h3>Setting</h3><p>Code blue data were collected across seven hospitals in Australia between July 2017 and August 2018.</p></div><div><h3>Participants</h3><p>Participants who fulfilled E-CPR selection criteria during IHCA were included.</p></div><div><h3>Main outcome measures</h3><p>Return of spontaneous circulation and survival and functional outcome at hospital discharge. Functional outcome was measured using the modified Rankin scale, with scores dichotomised into good and poor functional outcome.</p></div><div><h3>Results</h3><p>Twenty-three (23/144; 16%) patients fulfilled E-CPR selection criteria during IHCA, and 11/23 (47.8%) had a poor outcome. Patients with a poor outcome were more likely to have a non-shockable rhythm (81.8% vs. 16.7%; <em>p</em> = 0.002), and a longer duration of CPR (median 12.5 [5.5, 39.5] vs. 1.5 [0.3, 2.5] minutes; <em>p</em> &lt; 0.001) compared to those with a good outcome. The majority of patients (18/19 [94.7%]) achieved sustained return of spontaneous circulation within 15 minutes of CPR. All five patients who had CPR &gt;15 minutes had a poor outcome.</p></div><div><h3>Conclusion</h3><p>Approximately one in six IHCA patients fulfilled E-CPR selection criteria during IHCA, half of whom had a poor outcome. Non-shockable rhythm and longer duration of CPR were associated with poor outcome. Patients who had CPR for &gt;15 minutes and a poor outcome may have benefited from E-CPR. The feasibility, effectiveness and risks of commencing E-CPR earlier in IHCA and among those with non-shockable rhythms requires further investigation.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 90-96"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49713690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental sustainability in the intensive care unit: A toolkit to counter futility!","authors":"Deepak Bhonagiri MBBS, MD, FCICM,&nbsp;Mary Pinder MBBS, FCICM,&nbsp;Sue Huckson BAppSc, ICU Cert","doi":"10.1016/j.ccrj.2023.04.001","DOIUrl":"10.1016/j.ccrj.2023.04.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 61-62"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46460778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care unit admission from the emergency department in the setting of National Emergency Access Targets","authors":"Jack D'Arcy MB, BCh, BAO(Hons), FCICM, FACEM ,&nbsp;Suzanne Doherty MB, BCh, BAO(Hons), FACEM ,&nbsp;Luke Fletcher MBBS(Hons), BMedSc(Hons), MMed(Periop) ,&nbsp;Ary Serpa Neto MD, MSc, PhD ,&nbsp;Daryl Jones BSc(Hons), MBBS, FRACP, FCICM, MD, PhD","doi":"10.1016/j.ccrj.2023.05.005","DOIUrl":"10.1016/j.ccrj.2023.05.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Since the introduction of National Emergency Access Targets (NEATs) in 2012 there has been little research examining patients admitted to the intensive care unit (ICU).</p><p>We assessed differences in baseline characteristics and outcomes of patients admitted from the Emergency Department (ED) to the ICU within 4 hours compared with patients who were not.</p></div><div><h3>Methods</h3><p>This retrospective observational study included all adults (≥18 years old) admitted to the ICU from the ED of Austin Hospital, Melbourne, Australia, between 1 January 2017 and 31st December 2019 inclusive.</p></div><div><h3>Results</h3><p>1544 patients were admitted from the ED to the ICU and 65% had an ED length of stay (EDLOS) &gt; 4 hour. Such patients were more likely to be older, female, with less urgent triage category scores and lower illness severity. Sepsis and respiratory admission diagnoses, and winter presentations were significantly more prevalent in this group.</p><p>After adjustment for confounders, patients with an EDLOS &gt; 4 hours had lower hospital mortality; 8% v 21% (p = 0.029; OR, 1.62), shorter ICU length of stay 2.2 v 2.4 days (p = 0.043), but a longer hospital length of stay 6.2 v 6.8 days (p = &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Almost two thirds of patients breached the NEAT of 4 hours. These patients were more likely to be older, female, admitted in winter with sepsis and respiratory diagnoses, and have lower illness severity and less urgent triage categories. NEAT breach was associated with reduced hospital mortality but an increased hospital length of stay.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 84-89"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46596261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompensated metabolic acidosis in the emergency department: Epidemiology, sodium bicarbonate therapy, and clinical outcomes","authors":"Christopher Guy Dr, MBBS, MPH ,&nbsp;Natasha E. Holmes Associate Professor, MBBS, PhD ,&nbsp;Kartik Kishore Master of Data Science ,&nbsp;Nada Marhoon Post-Graduate Diploma in Data Science ,&nbsp;Ary Serpa-Neto Dr, MD, MSc, PhD","doi":"10.1016/j.ccrj.2023.05.003","DOIUrl":"10.1016/j.ccrj.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>This article aims to describe the epidemiology of decompensated metabolic acidosis, the characteristics of sodium bicarbonate (SB) administration and outcomes in emergency department (ED) patients.</p></div><div><h3>Design</h3><p>This is a retrospective cohort study.</p></div><div><h3>Setting</h3><p>ED of a tertiary referral hospital in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients presenting to the ED between 1 July 2011 and 20 September 2020 with decompensated metabolic acidosis diagnosed on arterial blood gas (ABG).</p></div><div><h3>Main outcome measures</h3><p>We compared characteristics between those treated with or without SB. We studied SB administration characteristics, change in laboratory variables, factors associated with use and dose, and clinical outcomes.</p></div><div><h3>Results</h3><p>Among 753,613 ED patients, 314 had decompensated metabolic acidosis on ABG, with 17.8% receiving SB. Patients in the SB group had lower median pH, CO2, bicarbonate, and base excess (BE) levels compared with the No SB group (<em>P</em> &lt; 0.01). The median number of SB doses in the SB group was one treatment. This was given at a median total dose of 100 mmol and at a median of 2.8 h after the diagnostic blood gas results. Only 42% of patients in the SB group had a subsequent blood gas measured. In such patients, there was no significant change in pH, bicarbonate, or BE. SB therapy was not independently associated with mortality.</p></div><div><h3>Conclusions</h3><p>ABG-confirmed decompensated metabolic acidosis was rare but associated with a high mortality. SB administration occurred in a minority of patients and in more acidaemic patients. However, SB dose was stereotypical and not tailored to acidosis severity. Assessment of SB effect was infrequent and showed no correction of acidosis. Systematic studies of titrated SB therapy are required to inform current practice.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 71-77"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43555338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LOVIT or leave it: The vitamin C debate continues","authors":"Yugeesh R. Lankadeva PhD,&nbsp;Darius JR. Lane PhD,&nbsp;Connie PC. Ow PhD,&nbsp;David A. Story MD, PhD,&nbsp;Mark P. Plummer MD, PhD,&nbsp;Clive N. May PhD","doi":"10.1016/j.ccrj.2023.05.001","DOIUrl":"10.1016/j.ccrj.2023.05.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 63-64"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44551680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}