Australian Critical Care最新文献

{"title":"Association of net ultrafiltration intensity and clinical outcomes among critically ill patients receiving continuous renal replacement therapy: A systematic review, meta-analysis, and trial sequential analysis","authors":"Lu Jin MBBS,&nbsp;Peiyun Li MM,&nbsp;Qing Xu MBBS,&nbsp;Fang Wang MD,&nbsp;Ling Zhang MD, PhD","doi":"10.1016/j.aucc.2024.101170","DOIUrl":"10.1016/j.aucc.2024.101170","url":null,"abstract":"<div><h3>Background</h3><div>Net ultrafiltration (UF^net) has been used in the fluid management of critically ill patients undergoing continuous renal replacement therapy for an extended duration. Despite its widespread application, the correlation between UF^net intensity and clinical outcomes remains controversial.</div></div><div><h3>Methods</h3><div>Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to November 30, 2023. All possible studies that examined the following outcomes were included: all-cause mortality, recovery of kidney function, and length of hospital stay.</div></div><div><h3>Results</h3><div>A total of 6209 patients from six cohort studies were included. There was no significant association observed between UF^net intensity and either mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.68–1.21, p = 0.49, I² = 84%) or renal recovery (OR = 0.96, 95% CI = 0.57–1.61, p = 0.87, I² = 75%) among critically ill patients. However, a high intensity of UF^net was associated with lower mortality in patients with acute kidney injury (AKI) (OR = 0.73, 95% CI = 0.59–0.90, p = 0.004, I² = 67%). Furthermore, the study revealed a noteworthy correlation between a high UF^net intensity and a longer length of hospital stay (weighted mean difference = 3.34 d, 95% CI = 2.64–4.03, p² = 0%).</div></div><div><h3>Conclusions</h3><div>The association between UF^net intensity and mortality or renal recovery in critically ill patients is insufficient. However, a high UF^net intensity is associated with an increasing length of hospital stay among critically ill patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101170"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airborne personal protective equipment availability and preparedness in Australian and New Zealand intensive care units: A point prevalence survey","authors":"Adrian Regli FCICM, PhD ,&nbsp;Edward Litton FCICM, PhD ,&nbsp;Annemarie Palermo RN ,&nbsp;Naomi Hammond RN, PhD ,&nbsp;Serena Knowles RN, PhD ,&nbsp;Britta Sylvia von Ungern-Sternberg FANZCA, PhD ,&nbsp;the Point Prevalence Program Management Committee, The Australian and New Zealand Intensive Care Society Clinical Trials Group and The George Institute for Global Health","doi":"10.1016/j.aucc.2024.101163","DOIUrl":"10.1016/j.aucc.2024.101163","url":null,"abstract":"<div><h3>Background</h3><div>Personal protective equipment is essential to protect healthcare workers when exposed to aerosol-generating procedures in patients with airborne respiratory pathogens.</div></div><div><h3>Aim</h3><div>This study aimed to provide information regarding the level of airborne protection offered to nursing staff and other healthcare workers in Australian and New Zealand intensive care units (ICUs) 1 year into the coronavirus disease 2019 pandemic.</div></div><div><h3>Methods</h3><div>In this cross-sectional survey, ICUs in Australia and New Zealand were asked to participate in the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program in June 2021. Sites were asked to contribute to questions regarding airborne protection offered to nursing staff and other healthcare workers.</div></div><div><h3>Results</h3><div>There were 51 participating sites. Negative-pressure bed space availability within participating ICUs included 24 with more than two, 15 with two, eight with one, and one ICU that did not have any. The median (interquartile range) number of different models and sizes of N95/P2 masks available to ICU staff was 6 (4–7). Of the 1018 nursing staff working that day in the units, 799 (78.5%) had at least one fit-tested N95/P2 mask in the correct size available. A total of 712 patients (461 medical and 251 surgical) were cared for by 700 bedside nurses in these ICUs. Overall, adequate airborne protection preparedness (airborne personal protective equipment training and fit-testing since the pandemic) was present in 548 (78.3%) bedside nurses.</div></div><div><h3>Conclusions</h3><div>Over a year into the coronavirus disease 2019 pandemic, airborne protection provided to nursing and other healthcare staff in Australia and New Zealand was often inadequate<strong>.</strong></div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101163"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of anxiety, depression, stress, job burnout, and characteristics of sleep disorders in critical care nurses: An observational study","authors":"Francesco Gravante RN, MSN ,&nbsp;Gianluca Pucciarelli RN, PhD, FAHA ,&nbsp;Francesca Sperati BSc, MStat ,&nbsp;Luciano Cecere RN, MSN ,&nbsp;Giuliano Anastasi RN, MSN ,&nbsp;Stefano Mancin RN, PhD ,&nbsp;Teresa Rea RN, PhD ,&nbsp;Roberto Latina RN, PhD","doi":"10.1016/j.aucc.2024.101165","DOIUrl":"10.1016/j.aucc.2024.101165","url":null,"abstract":"<div><h3>Aim/Objective</h3><div>The aim of this study was to determine risk factors and associations between anxiety, depression, stress, and job burnout and describe sleep disorders in critical care nurses.</div></div><div><h3>Setting</h3><div>Data were collected in six intensive care units.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was used. Multivariate and univariate regressions were used to determine significant risk factors. Significance levels were established at p &lt;0.05. We use Depression Anxiety Stress Scales to determine anxiety, depression, and stress. Work burnout was detected using the Maslach Burnout Inventory scale, and sleep quality was determined by the Pittsburgh Sleep Quality Index.</div></div><div><h3>Results</h3><div>A total of 140 critical care nurses were included. The female gender was associated with high levels of anxiety (odds ratio [OR] = 3.03; 95% confidence interval [CI] = [1.12–8.23]; p = 0.029), depression (OR = 10.55; 95% CI = [2.17–51.19]; p = 0.003), and stress (OR = 2.87; 95% CI = [1.02–8.07]; p = 0.045). Multivariate regression showed that critical care nurses with intention of leaving were exposed to high levels of anxiety (OR = 3.65; 95% CI = [1.40–9.53]; p = 0.008), depression (OR = 6.79; 95% CI = [2.01–22.95]; p = 0.002), stress [OR = 4.13; 95% CI = [1.49–11.45]; p = 0.006), and burnout (OR = 4.15; 95% CI = [1.63–10.56]; p = 0.003). Sleep quality is influenced by high latency, low duration, the use of medications, and daytime dysfunction.</div></div><div><h3>Conclusion</h3><div>Females were exposed to a higher risk of developing mental health problems such as anxiety, depression, and stress than men. The intention to leave was an independent predictor of anxiety, depression, and stress. Characteristics such as high sleep latency, low duration, use of medications, and daytime dysfunction have a negative impact on sleep quality. Early detection of mental health would allow nursing managers to implement nonpharmacological preventive interventions to improve well-being at work.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101165"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care clinician attitudes and perceptions towards whānau participation in adult intensive care bedside ward rounds in Aotearoa New Zealand: An online survey","authors":"Kadilu Chinyama-Kulakov RN, MN ,&nbsp;John Parsons NZRP, PhD ,&nbsp;Rachael L. Parke RN, PhD","doi":"10.1016/j.aucc.2024.101167","DOIUrl":"10.1016/j.aucc.2024.101167","url":null,"abstract":"<div><h3>Background</h3><div>Clinical practice guidelines endorse family involvement in ward rounds to improve communication and engagement between patients, whānau (family), and healthcare teams, yet the practice has not been universally implemented. Whānau inclusion in adult bedside rounds is often met with hesitation by intensive care unit (ICU) healthcare clinicians, and reasons for this have not been explored in Aotearoa, New Zealand.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess attitudes and perceptions of ICU clinicians towards whānau-family inclusion in adult ICU ward rounds in Aotearoa New Zealand.</div></div><div><h3>Methods</h3><div>A national, prospective, cross-sectional survey using a self-administered online questionnaire was distributed to three metropolitan ICUs in Aotearoa, New Zealand, and members of the New Zealand College of Critical Care Nurses and the College of Intensive Care Medicine of Australia and New Zealand in the period July–December 2020.</div></div><div><h3>Results</h3><div>In total, 188 ICU physicians, nurses, and allied health professionals responded. Over half of respondents strongly (23.4%) or somewhat agreed (29.3%) that whānau-family members should be given the option to attend bedside rounds, whereas more than half reported having had a positive experience when whānau-family had been present on rounds. Less experienced nurses were more likely to ask whānau-family to leave during rounds than more experienced nurses (46.5% vs 38.2%, respectively, p = 0.006). Clinicians voiced concern that whānau-family inclusion would prolong rounds, reduce teaching opportunities, constrain discussion of sensitive information, and compromise patient confidentiality. However, they also said that whānau-family-centred rounds were useful to better inform whānau-family members and to facilitate culturally safe practice.</div></div><div><h3>Conclusion</h3><div>Intensive care clinicians demonstrated positive attitudes and perceptions towards whānau-family-centred ward rounds, but concerns regarding the structure and quality of rounds were raised. Clinicians recognise whānau-family-centred rounds as an opportunity to enhance communication and facilitate culturally safe practice. Education regarding the benefits of whānau-family-centred rounds to facilitate implementation is required.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101167"},"PeriodicalIF":2.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inspiratory effort and respiratory muscle activation during different breathing conditions in patients with weaning difficulties: An exploratory study","authors":"Diego Poddighe PT, MSc ,&nbsp;Marine Van Hollebeke PT, PhD ,&nbsp;Beatrix Clerckx PT, MSc ,&nbsp;Luc Janssens MSc ,&nbsp;Geert Molenberghs PhD ,&nbsp;Lisa Van Dyck MD, PhD ,&nbsp;Jan Muller MD ,&nbsp;Jan Gunst MD, PhD ,&nbsp;Philippe Meersseman MD, PhD ,&nbsp;Marijke Peetermans MD, PhD ,&nbsp;Greet Hermans MD, PhD ,&nbsp;Rik Gosselink PT, PhD ,&nbsp;Daniel Langer PT, PhD","doi":"10.1016/j.aucc.2024.101152","DOIUrl":"10.1016/j.aucc.2024.101152","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies suggest that fast and deep inspirations against either low or high external loads may provide patients with weaning difficulties with a training stimulus during inspiratory muscle training (IMT). However, the relationship between external IMT load, reflected by changes in airway pressure swings (ΔPaw), and total inspiratory effort, measured by oesophageal pressure swings (ΔPes), remains unexplored. Additionally, the association between ΔPes, ΔPaw, and inspiratory muscle activations remains unclear.</div></div><div><h3>Objectives</h3><div>The ai of this study was to compare ΔPes and ΔPaw and their relationship with inspiratory muscle activation in patients with weaning difficulties during different breathing conditions.</div></div><div><h3>Methods</h3><div>ΔPes and scalene, sternocleidomastoid, and parasternal intercostal muscles activation were recorded during the following conditions: 1) (proportional) pressure support ventilation; 2) unsupported spontaneous breathing; 3) low-load IMT (load: &lt;10% maximal inspiratory pressure, PImax = 3 cmH₂O) executed with slow and deep inspirations (low-load slow) and 4) low-load <span>IMT</span> (load: &lt;10% maximal inspiratory pressure, PImax = 3 cmH₂O) executed with fast deep inspirations (low-load fast); and 5) high-load IMT (load ∼ 30% PImax) executed with fast and deep inspirations. ΔPaw, end-inspiratory lung volume, and peak inspiratory flow were recorded during conditions 2–5. Variables were compared across conditions using mixed-model analysis. Spearman's rank correlations were calculated between inspiratory muscle activations and both ΔPes and ΔPaw.</div></div><div><h3>Results</h3><div>Five patients (age: 68 ± 1 y; 20% male; PImax: 37 ± 7 cmH₂O [59 ± 23% predicted]; forced vital capacity: 0.66 ± 0.16 L [21 ± 6% predicted]) were included in the study. ΔPes values were 3–4 times larger than ΔPaw values during unsupported spontaneous breathing and IMT conditions. ΔPes, sternocleidomastoid activation, end-inspiratory lung volume, and peak inspiratory flow were larger during low-load fast IMT than during low-load slow IMT and unsupported spontaneous breathing but were similar between low-load fast and high-load IMTs. Inspiratory muscle activations correlated weakly to moderately with ΔPaw and moderately with ΔPes.</div></div><div><h3>Conclusions</h3><div>In five patients with weaning difficulties, low-load fast IMT provided a training stimulus similar to high-load IMT. Both yielded significantly higher training stimulus than low-load slow IMT and unsupported spontaneous breathing. These results should be considered in future trials comparing IMT with sham conditions.</div></div><div><h3>Clinical trial registration numbers</h3><div>NCT03240263 and NCT04658498.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101152"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking Outcomes Post Intensive Care: Findings of a longitudinal observational study","authors":"Dylan Flaws MBBS, FRANZCP, PhD ,&nbsp;Oystein Tronstad BPhys ,&nbsp;John F. Fraser MB ChB, FRCP (Glas), FFARCSI, FRCA, FCICM, FELSO, PhD ,&nbsp;Jayshree Lavana MBBS, MD (Gen Med), FCICM ,&nbsp;Kevin B. Laupland MD, FCICM, PhD ,&nbsp;Mahesh Ramanan MBBS, FCICM, PhD ,&nbsp;Alexis Tabah MD, FCICM, PhD ,&nbsp;Sue Patterson PhD","doi":"10.1016/j.aucc.2024.101164","DOIUrl":"10.1016/j.aucc.2024.101164","url":null,"abstract":"<div><h3>Background</h3><div>Many intensive care unit (ICU) survivors experience new or worsening impairments, termed post–intensive care syndrome. Substantial investment has been made in identifying patients at risk and developing interventions, but evidence remains equivocal. A more nuanced understanding of risk and outcomes is therefore warranted.</div></div><div><h3>Objectives</h3><div>This study aimed to describe patients’ health status 6 months after ICU discharge and characterise those with, and without, clinically significant physical, cognitive, or psychological impairments.</div></div><div><h3>Methods</h3><div>In this prospective, multisite observational study, patients discharged from four ICUs were screened and invited to participate. Consenting participants completed a questionnaire-based survey by telephone that encompassed preadmission characteristics and validated self-report questionnaires of physical and cognitive function, anxiety, depression, and post-traumatic stress disorder. Routine ICU data were collected from hospital records. Participants reporting clinically significant impairments were compared with those not reporting impairments on demographics and hospital data.</div></div><div><h3>Results</h3><div>A total of 132 participants completed 6-month follow-up: 30% reported impairments in any domain. Of these, 43% reported impairments in two or more domains. The rates of impairment varied between sites, ranging from 21% to 88%. Depression was most common, followed by physical impairment, anxiety, and cognitive impairment, with post-traumatic stress disorder being the least common.</div></div><div><h3>Participants</h3><div>Reporting impairments did not differ significantly from others on Acute Physiology and Chronic Health Evaluation II scores, delirium rates, mechanical ventilation rates, or duration and length of stay. Planned admissions were less common in the impairment group, as was inotrope use. Mental health diagnosis was not associated with post-ICU impairments.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the heterogeneity of patients experiencing impairments after ICU discharge and highlights the importance of attending to patients’ unique circumstances, encompassing characteristics and treatment factors, when assessing risk and planning support. Whilst generalisability is uncertain, these findings support a whole of health service approach towards post-ICU recovery.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101164"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey","authors":"David M. Golding MBBCh, BSc, PGDip ,&nbsp;Maxim Bloomfield MBChB, MSc, MPhil ,&nbsp;Joshua Davis MBBS, PhD ,&nbsp;Anthony Delaney MBBS, MSc, PhD ,&nbsp;Thomas Hills MBChB, MSc, DPhil ,&nbsp;Steven Y.C. Tong MBBS, PhD ,&nbsp;Paul J. Young MBChB, PhD","doi":"10.1016/j.aucc.2024.101155","DOIUrl":"10.1016/j.aucc.2024.101155","url":null,"abstract":"<div><h3>Objective</h3><div>Selective decontamination of the digestive tract (SDD) has been investigated as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP) and other healthcare-associated infections in intensive care unit (ICU) patients receiving mechanical ventilation. There is some evidence to suggest that the use of SDD is associated with a reduction in healthcare-associated infection and mortality; however, the uptake of SDD in ICUs in Australia and New Zealand (ANZ) remains low. To better understand the potential reasons, we designed a questionnaire to gather views from specialists in intensive care medicine, infectious diseases, and medical microbiology.</div></div><div><h3>Design</h3><div>The study incorporated an online survey.</div></div><div><h3>Setting and participants</h3><div>An online survey was distributed to specialists in intensive care medicine, infectious diseases, and medical microbiology working in ANZ.</div></div><div><h3>Main outcome measures</h3><div>The main outcome measures are views about SDD and perceived barriers to implementation in ICUs in ANZ.</div></div><div><h3>Results</h3><div>A total of 103 responses were obtained, of which 55 were from intensive care medicine specialists and the remainder from infectious disease/medical microbiology specialists. No respondents currently used SDD in their hospital ICU. Intensive care medicine specialists self-reported better understanding of the evidence base regarding SDD (P = 0.032) and were more likely to believe that SDD was a safe therapy (P &lt; 0.001) and that it was associated with a reduction in the incidence of VAP (P &lt; 0.001) and ICU mortality (P &lt; 0.001). Infectious disease/medical microbiology specialists were more likely to believe there is currently a lack of evidence of benefit (P &lt; 0.001) and a risk of harm (P &lt; 0.001) associated with SDD.</div></div><div><h3>Conclusions</h3><div>Specialists in intensive care medicine had more positive views about use of SDD in ventilated patients than did specialists in infectious diseases/medical microbiology, but no respondents reported using SDD in their clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101155"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events associated with umbilical vascular catheters in neonatal intensive care: Development of a risk prediction model","authors":"Kim Gibson BN, MN ,&nbsp;Amber Smith BN, MN ,&nbsp;Rebecca Sharp BN, BHSc (Hons), PhD ,&nbsp;Amanda Ullman BN, PhD ,&nbsp;Scott Morris MBBS, PhD, FRACP ,&nbsp;Adrian Esterman MSc, PhD, BSc (hons)","doi":"10.1016/j.aucc.2024.101146","DOIUrl":"10.1016/j.aucc.2024.101146","url":null,"abstract":"<div><h3>Background</h3><div>Adverse events associated with umbilical vascular catheters occur frequently in the neonatal intensive care unit. International guidelines recommend limiting catheter dwell time to reduce the risk of adverse events, and this drives clinical decision-making regarding catheter removal, yet other risk factors may also influence the risk of adverse events.</div></div><div><h3>Objectives</h3><div>The aim of this study was to develop a clinically useful risk prediction model that could be utilised in the neonatal intensive care unit to identify infants at a greater risk of developing an adverse event associated with umbilical vascular catheters.</div></div><div><h3>Methods</h3><div>A risk prediction model was developed for the umbilical venous catheter and umbilical arterial catheter based on the dataset of a published retrospective cohort study in a South Australian neonatal intensive care unit. Least absolute shrinkage and selection operator regression was used to develop the model. Deviance was used to evaluate the model's goodness of fit, and the Hosmer–Lemeshow test and calibration plot were used to assess calibration. The area under the receiver operating characteristic curve evaluated the model's discrimination.</div></div><div><h3>Results</h3><div>For adverse events associated with umbilical venous catheters, the least absolute shrinkage and selection operator model selected none of the potential predictor variables. Five predictors of adverse events were identified for umbilical arterial catheters: thrombocytopaenia, intrauterine growth restriction/small for gestational age, congenital heart disease/defects including patent ductus arteriosus, maternal diabetes, and a dwell time of &gt;7 days. The area under the receiver operating characteristic curve was 0.68 (95% confidence interval: 0.61–0.74). A link test found that the model was properly specified, and a Hosmer–Lemeshow test demonstrated that the model was well calibrated (p = 0.104).</div></div><div><h3>Conclusions</h3><div>A risk prediction model has been developed to identify infants at a greater risk of an adverse event associated with umbilical arterial catheters. The model needs to be externally validated before it can be implemented into clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101146"},"PeriodicalIF":2.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events during and after early mobilisation: A post hoc analysis of the TEAM trial","authors":"Tessa Broadley BBiomedSc(Hons) ,&nbsp;Ary Serpa Neto MD, PhD ,&nbsp;Michael Bailey PhD ,&nbsp;Rinaldo Bellomo MD, FCICM, PhD ,&nbsp;Kathy Brickell RGN ,&nbsp;Heidi Buhr RN, MScMed(ClinEpid) ,&nbsp;Belinda J. Gabbe BPhysio(Hons), PhD ,&nbsp;Doug W. Gould PhD ,&nbsp;Meg Harrold BSc Physiotherapy, PhD ,&nbsp;Sally Hurford PGDip ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Alistair D. Nichol MD, PhD ,&nbsp;Jeffrey J. Presneill MBBS(Hons), PhD ,&nbsp;Stefan J. Schaller MD ,&nbsp;Janani Sivasuthan MPH ,&nbsp;Claire J. Tipping BPT(Hons), PhD ,&nbsp;Steven Webb MD, PhD ,&nbsp;Paul J. Young FCICM, PhD ,&nbsp;Alisa M. Higgins MPH, PhD ,&nbsp;Carol L. Hodgson PT, PhD","doi":"10.1016/j.aucc.2024.101156","DOIUrl":"10.1016/j.aucc.2024.101156","url":null,"abstract":"<div><h3>Background</h3><div>The Treatment of Mechanically Ventilated Adults with Early Activity and Mobilisation (TEAM) trial reported a higher occurrence of adverse events with greater mobilisation. However, their timing and nature remained unexplored. We conducted an in-depth exploration of such events.</div></div><div><h3>Objective</h3><div>The purpose of this paper is to thoroughly examine the timing and characteristics of adverse events reported within the TEAM trial.</div></div><div><h3>Methods</h3><div>Adverse event data were collected daily in real time. Categorical data were compared using the Fisher's exact test. The relationship between adverse events and patient survival was analysed using a Cox-regression frailty model.</div></div><div><h3>Results</h3><div>Overall, 37 out of 371 patients (10.0%) in the early mobilisation group and 16 out of 370 patients (4.3%) in the usual care group experienced adverse events, with 71 events in the early mobilisation group compared to 24 events in the usual care group. The most common adverse events were altered blood pressure in 21 out of 53 patients (39.6%), arrhythmia in 17 out of 53 patients (32.1%), and oxygen desaturation in nine of 53 patients (17.0%). Patients with an adverse event were more likely to have congestive heart failure (absolute percentage difference: 16.1, 95% confidence interval [CI]: 6.1 to 26.1), peripheral vascular disease (absolute percentage difference: 6.4, 95% CI: 1.3 to 11.5), heart attack (absolute percentage difference: 13.5, 95% CI: 5.9 to 21.1), or stroke (absolute percentage difference: 9.3, 95% CI: 3.5 to 15.1). Adverse events occurred at a median of 4 days with early mobilisation and 7 days with usual care. There was no significant difference in survival for patients who experienced an adverse event compared to those without an adverse event.</div></div><div><h3>Conclusion</h3><div>Adverse events were more common in patients randomised to early active mobilisation, were cardiovascular and respiratory in nature, tended to occur earlier with active mobilisation, and cardiovascular comorbidities were more common in such patients. This information can help guide future studies in this field.</div></div><div><h3>Trial registration</h3><div>TEAM <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> number, NCT03133377, registered 28 April 2017.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101156"},"PeriodicalIF":2.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and long-term outcomes of pulmonary emphysema patients on mechanical ventilation admitted to the intensive care unit for acute respiratory failure: A retrospective observational study","authors":"Alexandre Ponsin M.D. ,&nbsp;Coralie Barbe M.D. ,&nbsp;Leïla Bouazzi B.S.T. ,&nbsp;Clémence Loiseau ,&nbsp;Philippe Cart M.D. ,&nbsp;Jérémy Rosman M.D.","doi":"10.1016/j.aucc.2024.101151","DOIUrl":"10.1016/j.aucc.2024.101151","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute respiratory failure is a leading cause of admission to the intensive care unit (ICU), with mortality rates remaining stagnant despite advances in resuscitation techniques. Comorbidities, notably chronic obstructive pulmonary disease, significantly impact ICU patient outcomes. Pulmonary emphysema, commonly associated with chronic obstructive pulmonary disease, poses a significant risk, yet its influence on ICU mortality remains understudied.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the short- and long-term outcomes of ICU patients with pulmonary emphysema requiring mechanical ventilation for acute respiratory failure, evaluating the impact of emphysema severity.</div></div><div><h3>Methods</h3><div>A single-centre retrospective cohort study was conducted from 2015 to 2021. Patients with pulmonary emphysema requiring invasive ventilation were included. Emphysema severity was assessed using chest computed tomography scans. Data on mortality, length of stay, and ventilator-free days were collected. Statistical analyses were performed to identify factors associated with outcomes.</div></div><div><h3>Results</h3><div>Of the 89 included patients, 31.5% died during their ICU stay, with a 39.3% mortality within 12 months postdischarge. Emphysema severity did not significantly correlate with mortality or ventilator-free days. Chronic heart failure emerged as a significant predictor of ICU and in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Emphysema severity does not appear to independently affect mortality in intubated ICU patients with acute respiratory failure. However, mortality rates remain high, warranting further investigation into contributing factors. Our findings underline the complexity of managing critically ill patients with pulmonary emphysema and emphasise the need for comprehensive patient assessment and personalised treatment approaches.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101151"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}